| Anthem Blue Cross (HMO, PPO, EPO) |
| imatinib (imatinib) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 1 bottle per 30 day(s).
- Step Therapy: ST_APPLIES
- Quantity Limit: 1 tablet per 1 day(s).
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- Quantity Limit: limit maximum 8 EA PER 30 day(s)
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