| Anthem Blue Cross (HMO, PPO, EPO) |
| Vyvgart (efgartigimod alfa-fcab) |
| Drugs for Nerves and Muscles : Drugs for Nerves and Muscles |
- Available only through Specialty Pharmacy;
- Prior Authorization: Myasthenia Gravis:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 26 week(s)
Reauthorization Required: Yes
- Myasthenia Gravis:
Age Requirement: >= 18
Duration: 26 week(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 1 year(s)
|