Anthem Blue Cross (HMO, PPO, EPO) |
Lenvima (24 MG Daily Dose) (lenvatinib) |
Drugs for Cancer : Drugs for Cancer |
- ST_APPLIES
- Quantity Limit: 204 lancets per 30 day(s).
- Quantity Limit: limit maximum 90 EA PER 30 day(s)
- Assisted Reproductive Technology (ART):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- Prior Authorization: Respiratory Syncytial Virus (RSV):
Documented Diagnosis: Yes
Duration: 5 Month(s)
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