| Anthem Blue Cross (HMO, PPO, EPO) |
| Rybrevant (amivantamab-vmjw) |
| Drugs for Cancer : Drugs for Cancer |
- Available only through Specialty Pharmacy;
- Quantity Limit: 1 tablet per 1 day(s).
- Prior Authorization: Growth Hormone Deficiency:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
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