| Anthem Blue Cross (HMO, PPO, EPO) |
| Erbitux (cetuximab) |
| Drugs for Cancer : Drugs for Cancer |
- Osteoarthritis: OA of the Knee:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Orthopedic Specialist;Rheumatologist;Sports Medicine Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Elapsed Duration Since Previous Course of Therapy: 6 month(s)
- Quantity Limit: 1 tablet per 1 day(s).
- Available only through Specialty Pharmacy; May process through Pharmacy or Medical benefit depending on Patient location;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
- Quantity Limit: limit maximum 3 EA PER 1 day(s)
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