| Anthem Blue Cross (HMO, PPO, EPO) |
| ZTlido (lidocaine) |
| Drugs for the Skin : Drugs for the Skin |
- Step Therapy Applies
- Prior Authorization: Post-herpetic Neuralgia:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Post-herpetic Neuralgia:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 3 patches per 1 day(s).
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