| Anthem Blue Cross (HMO, PPO, EPO) |
| Vectibix (panitumumab) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Narcolepsy Type 1, Narcolepsy Type 2:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 7
Duration: 6 Month(s)
Reauthorization Required: Yes
Neurology: Narcolepsy:
PA Applies
- Quantity Limit: limit maximum 40 EA PER 23 day(s)
- Zero copay may apply.
- Quantity Limit: limit maximum 200 EA PER 30 day(s)
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