| Anthem Blue Cross (HMO, PPO, EPO) |
| cidofovir (cidofovir) |
| Drugs for Infections : Drugs for Viral Infections |
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Cytomegalovirus (CMV):
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Cytomegalovirus (CMV):
Duration: 1 year(s)
|