Anthem Blue Cross (HMO, PPO, EPO)
Plegridy Starter Pack (peginterferon beta-1a)
Drugs for the Nervous System : Drugs for Multiple Sclerosis
  • PA Applies
  • Available only through Specialty Pharmacy;
    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;
  • Multiple Sclerosis (MS):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Patients Cardiac Medical History Required: No
    Concomitant use of other MS medication: No

  • Prior Authorization: Multiple Sclerosis (MS):
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Quantity Limit: limit maximum 1 mL PER 28 day(s)