| Anthem Blue Cross (HMO, PPO, EPO) |
| Xenical (orlistat) |
| Drugs for Eating Disorders : Drugs for Eating Disorders |
- Step Therapy: Obesity:
ST Multiple Generics
- Quantity Limit: 3 capsules per 1 day(s).
- Obesity:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Obesity:
Duration: 1 year(s)
|