| Anthem Blue Cross (HMO, PPO, EPO) |
| Fotivda (tivozanib) |
| Drugs for Cancer : Drugs for Cancer |
- Macular Edema:
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 2 tablets per 1 day(s).
- ST_APPLIES
- Prior Authorization: PA Applies
|