Anthem Blue Cross (HMO, PPO, EPO)
Lenvima (20 MG Daily Dose) (lenvatinib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 1 capsule per 1 day(s).
  • Quantity Limit: limit maximum 180 EA PER 30 day(s)
  • Psoriasis (PsO):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 3
    Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Psoriatic Arthritis (PsA):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    TB Test required: No

  • Quantity Limit: limit maximum 30 day(s) supply
  • Cytomegalovirus (CMV):
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Step Therapy: Gastro: IBS-C:
    Step Applies
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