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).