| Anthem Blue Cross (HMO, PPO, EPO) |
| Xospata (gilteritinib) |
| Drugs for Cancer : Drugs for Cancer |
- 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
- Available through Specialty Pharmacy;
- PA Required
- QL (30 per Rx);
- Step Therapy: ST_APPLIES
- Prior Authorization: PA Applies
|