| Anthem Blue Cross (HMO, PPO, EPO) |
| Exkivity (mobocertinib) |
| Drugs for Cancer : Drugs for Cancer |
- PA_APPLIES
- Prior Authorization: Erectile Dysfunction (ED):
Documented Diagnosis: Yes
Age Requirement: >= 18
Gender Requirement: Male
Duration: 6 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 30 day supply per 1 fill(s).
- PA_APPLIES
- Step Therapy: Growth Hormone Deficiency:
ST Multiple Brands
|