| Anthem Blue Cross (HMO, PPO, EPO) |
| Phesgo (pertuzumab-trastuzumab-hy-zzxf) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 5 ML PER fill retail
- Quantity Limit: 20 mL per day
- Prior Authorization: Obesity:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 16 week(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 20 EA PER 25 day(s)
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