Anthem Blue Cross (HMO, PPO, EPO)
Nexviazyme (avalglucosidase alfa-ngpt)
Drugs for Metabolic Disease : Drugs for Metabolic Disease
  • ST_APPLIES
  • ST_APPLIES
  • Quantity Limit: limit maximum 30 day(s) supply
  • Pain Narcotic: Opioid:
    Duration: 24 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Diagnosis Type(s): 2 of Chronic Pain;Moderate to Severe Pain
    Used for Cancer Patients: Yes
    Around-The-Clock Analgesic Required: Yes
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No

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