Anthem Blue Cross (HMO, PPO, EPO)
Klisyri (tirbanibulin)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Actinic Keratosis:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Actinic Keratosis:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Quantity Limit: 5 packets per 1 fill(s).
  • Step Therapy: Actinic Keratosis:
    ST Single Generic

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