| Anthem Blue Cross (HMO, PPO, EPO) |
| Lyrica CR (pregabalin) |
| Drugs for the Nervous System : Drugs for Seizures /Personality Disorder/Nerve Pain |
- Quantity Limit: 2 tablets per 1 day(s).
- Post-herpetic Neuralgia:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Post-herpetic Neuralgia:
ST Multiple Generics
- Prior Authorization: Post-herpetic Neuralgia:
Duration: 1 year(s)
|