Anthem Blue Cross (HMO, PPO, EPO) |
Istodax (Overfill) (romidepsin) |
Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- PA Required
- ST_APPLIES
- Quantity Limit: 204 strips per 30 day(s).
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