| Anthem Blue Cross (HMO, PPO, EPO) |
| Prevymis (letermovir) |
| Drugs for Infections : Drugs for Viral Infections |
- Step Therapy Applies
- Quantity Limit: 100 tablets per 365 day(s).
- Available only through Specialty Pharmacy;
- Prior Authorization: Cytomegalovirus (CMV):
Duration: 1 year(s)
- Cytomegalovirus (CMV):
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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