| Anthem Blue Cross (HMO, PPO, EPO) |
| glyburide-metformin (glyburide-metformin) |
| Hormones : Drugs for Diabetes |
- Quantity Limit: 180 mL per 1 fill(s).
- Prior Authorization: Colorectal Cancer:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Melanoma (MEL):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Bone Loss Treatments:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- Prior Authorization: PA Required
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