| Anthem Blue Cross (HMO, PPO, EPO) |
| Tepmetko (tepotinib) |
| Drugs for Cancer : Drugs for Cancer |
- Major Depressive Disorder:
Duration: 3 Month(s)
Specialist Required: Yes
Medical Test Required: No
Specialist Type(s): 1 of Psychiatrist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Documented Diagnosis: Yes
- Step Therapy: Acromegaly:
ST Single Generic
- Prior Authorization: Acromegaly:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Neuroendocrine Tumor (NET), Oncology: Carcinoid Syndrome:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- Quantity Limit: limit maximum 120 ML PER 30 day(s)
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