Anthem Blue Cross (HMO, PPO, EPO) |
Lyumjev (insulin lispro-aabc) |
Hormones : Drugs for Diabetes |
- Prior Authorization: Endometriosis:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 30 day supply per 1 fill(s).
- Step Therapy: ST_APPLIES
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
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