| Anthem Blue Cross (HMO, PPO, EPO) |
| Lomaira (phentermine) |
| Drugs for Eating Disorders : Drugs for Eating Disorders |
- Prior Authorization: Obesity:
Documented Diagnosis: Yes
Duration: 12 week(s)
- Quantity Limit: 3 tablets per 1 day(s).
- Obesity:
Duration: 12 week(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
|