| Anthem Blue Cross (HMO, PPO, EPO) |
| Gavreto (pralsetinib) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Preventive Drug: $0 copay.
- Post-herpetic Neuralgia:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
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