| Anthem Blue Cross (HMO, PPO, EPO) |
| Mekinist (trametinib) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 200 EA PER 30 day(s)
- Quantity Limit: 204 strips per 30 day(s).
- Prior Authorization: PA Required
- Diabetes Type 2: SGLT2 + Combo:
Age Requirement: >= 18
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests;Medication History
- Available through Specialty Pharmacy;
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