| Anthem Blue Cross (HMO, PPO, EPO) |
| D.H.E. 45 (dihydroergotamine) |
| Drugs for the Nervous System : Drugs for Migraine Headaches |
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- PA Required
- MAC Lung Disease:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Infectious Disease Specialist;Pulmonologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Step Therapy: ST_APPLIES
- Preventive Drug: Zero copay.
- Quantity Limit: 3 tablets per 1 day(s).
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