| Anthem Blue Cross (HMO, PPO, EPO) |
| Lenvima (4 MG Daily Dose) (lenvatinib) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Diabetes Type 2: Test Strips:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: 30 day supply per 1 fill(s).
- QL (1 per Rx);
- ST_APPLIES
- Minimum Age: N.A.; Maximum Age: 29 Years;
- PA_APPLIES
|