Anthem Blue Cross (HMO, PPO, EPO)
Keytruda (pembrolizumab)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 1 inhaler per 30 day(s).
  • $0 limited to 2 treatment cycles/year
  • Hidradenitis Suppurativa (HS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)

    Psoriasis (PsO):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Uveitis:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): 1 of AllCare Plus Pharmacy;BriovaRx
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Cushings Syndrome:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

<< Return | Back to top