| Anthem Blue Cross (HMO, PPO, EPO) |
| Supprelin LA (histrelin) |
| Hormones : Drugs for Women |
- Step Therapy: ST_APPLIES
- PA_APPLIES
- Quantity Limit: limit maximum 6 EA PER 90 day(s)
- Prior Authorization: Parkinson's Disease:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- ST_APPLIES
|