| Anthem Blue Cross (HMO, PPO, EPO) |
| azacitidine (azacitidine) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: PA Applies
- Prior Authorization: Asthma (injectable), Nasal Polyposis:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
EGPA:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 3 ML PER fill retail
- PA_APPLIES
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