| Anthem Blue Cross (HMO, PPO, EPO) |
| Folotyn (pralatrexate) |
| Drugs for Cancer : Drugs for Cancer |
- Available only through Specialty Pharmacy;
- Quantity Limit: limit maximum 4 EA PER 28 day(s)
- Anti-Cancer:Maximum $200 copayment per State Law. New commercial members to be referred to AcariaHealth
- Quantity Limit: limit maximum 300 ML PER 25 day(s)
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