| Anthem Blue Cross (HMO, PPO, EPO) |
| IDHIFA (enasidenib) |
| Drugs for Cancer : Drugs for Cancer |
- QL applies to members age 65 and older
- Quantity Limit: Limit 8 inhalers per month;QL(0.27ml daily)
- PA Applies
- PA Applies
- Quantity Limit: Maximum quantity of 31 per 31 Day(s). Maximum quantity 1 tablet per day.
- Step Therapy: Diabetic Gastroparesis:
ST Single Generic
|