| Anthem Blue Cross (HMO, PPO, EPO) |
| Folotyn (pralatrexate) |
| Drugs for Cancer : Drugs for Cancer |
- Systemic Anaplastic Large Cell Lymphoma:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
- Available only through Specialty Pharmacy;
- Step Therapy: Systemic Anaplastic Large Cell Lymphoma:
ST Multiple Generics
- Prior Authorization: Systemic Anaplastic Large Cell Lymphoma:
Duration: 1 year(s)
|