| Anthem Blue Cross (HMO, PPO, EPO) |
| Byetta 10 MCG Pen (exenatide) |
| Hormones : Drugs for Diabetes |
- Prior Authorization: Major Depressive Disorder with Suicidal Ideation :
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 4 week(s)
- PA Applies
- Quantity Limit: 200 syringes per 30 day(s).
- Quantity Limit: limit maximum 4 ML PER 1 day(s)
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