Anthem Blue Cross (HMO, PPO, EPO)
Pifeltro (doravirine)
Drugs for Infections : Drugs for Viral Infections
  • Prior Authorization Required
  • Quantity Limit: 1 tablet per 1 day(s).

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on Quantity drug coverage click HERE;