| Anthem Blue Cross (HMO, PPO, EPO) |
| Xhance (fluticasone propionate) |
| Drugs for the Nose : Allergy |
- Step Therapy Applies
- Prior Authorization: Nasal Polyposis:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- Nasal Polyposis:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 2 inhalers per 30 day(s).
|