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)