Anthem Blue Cross (HMO, PPO, EPO) |
Oncaspar (pegaspargase) |
Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Prior Authorization: Alzheimer's Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 50
Duration: 6 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: limit maximum 60 GM PER 25 day(s)
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