| Anthem Blue Cross (HMO, PPO, EPO) |
| Saphris (asenapine maleate) |
| Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Step Therapy Applies
- Bipolar:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Bipolar:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: 2 tablets per 1 day(s).
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