| Anthem Blue Cross (HMO, PPO, EPO) |
| Pomalyst (pomalidomide) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Prior Authorization: PA_APPLIES
- PA Applies
- May be covered under Medical Benefit.
- Prior Authorization: Glaucoma:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
|