| Anthem Blue Cross (HMO, PPO, EPO) |
| Provenge (sipuleucel-T-lactated ringers) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Prior Authorization: Diabetic Medical Supplies:
Duration: 1 year(s)
- PA_APPLIES
- Diabetic Medical Supplies:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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