Anthem Blue Cross (HMO, PPO, EPO)
FazaClo (clozapine)
Drugs for the Nervous System : Drugs for Severe Mental Disorders
  • Quantity Limit: 9 tablets per 1 day(s).
  • Step Therapy: Psychiatry: Schizophrenia:
    ST Single Generic

  • Psychiatry: Schizophrenia:
    Age Requirement: > 17
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: No
    Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
    Established tolerability to oral formulation: No
    Documented Diagnosis: No

  • Prior Authorization: Psychiatry: Schizophrenia:
    Age Requirement: > 17
    Duration: 12 Month(s)

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