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