| Anthem Blue Cross (HMO, PPO, EPO) |
| Ruxience (rituximab-pvvr) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Step Therapy: Ulcerative Colitis (UC):
ST Multiple Brands
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Prior Authorization: PA_APPLIES
- Quantity Limit: limit maximum 40 EA PER 90 day(s)
|