Anthem Blue Cross (HMO, PPO, EPO)
Follistim AQ 75 Unit/0.5 Ml Soln (follitropin beta)
Hormones : Drugs for Women
  • Step Therapy: Assisted Reproductive Technology (ART):
    ST Single Brand

  • 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

  • Prior Authorization: Assisted Reproductive Technology (ART):
    Documented Diagnosis: Yes
    Duration: 1 year(s)

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