| Anthem Blue Cross (HMO, PPO, EPO) |
| Elaprase (idursulfase) |
| Drugs for Metabolic Disease : Drugs for Metabolic Disease |
- Prior Authorization: PA Required
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Step Therapy: Antiviral: Hepatitis C (HCV):
ST Single Brand
|