| Anthem Blue Cross (HMO, PPO, EPO) |
| Trelegy Ellipta (fluticasone-umeclidin-vilanter) |
| Drugs for the Lungs : Drugs for Cystic Fibrosis |
- Step Therapy Applies
- Asthma (oral):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Asthma (oral):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
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