| Anthem Blue Cross (HMO, PPO, EPO) |
| HumuLIN R U-500 KwikPen (insulin regular hum U-500 conc) |
| Hormones : Drugs for Diabetes |
- PA_APPLIES
- Prior Authorization: PA_APPLIES
- Quantity Limit: limit maximum 2 ML PER 30 day(s)
- Prior Authorization: NSCLC ALK+ OR ROS1+ Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
|