Anthem Blue Cross (HMO, PPO, EPO) |
Victoza (liraglutide) |
Hormones : Drugs for Diabetes |
- Prior Authorization: PA Required
- Prior Authorization: PA_APPLIES
- Prior Authorization: Chorea in Huntington's Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
Tardive Dyskinesia (TD): Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
- Prior Authorization: PA_APPLIES
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