| Anthem Blue Cross (HMO, PPO, EPO) |
| phenelzine (phenelzine) |
| Drugs for the Nervous System : Drugs for Depression |
- Prior Authorization: Migraine:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
Migraine Prevention:
Documented Diagnosis: Yes
Duration: 6 Month(s)
|