| Anthem Blue Cross (HMO, PPO, EPO) |
| Jemperli (dostarlimab-gxly) |
| Drugs for Cancer : Drugs for Cancer |
- High Risk Medications require PA for members age 70 and older
- Quantity Limit: 30 day supply per 1 fill(s).
- Quantity Limit: 300 lancets per prescription
- Prior Authorization: Osteoarthritis: OA of the Knee:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
|