| Anthem Blue Cross (HMO, PPO, EPO) |
| Bylvay (odevixibat) |
| Drugs for the Liver : Drugs for the Liver |
- Quantity Limit: 5 capsules per 1 day(s).
- PA Applies
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE- Cholestatic Liver Disease:
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Cholestatic Liver Disease:
Documented Diagnosis: Yes
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