Anthem Blue Cross (HMO, PPO, EPO)
Pylera (bismuth subcit K-metronidz-tcn)
Drugs for the Stomach : Drugs for Ulcers and Stomach Acid
  • Step Therapy: H. Pylori Infection:
    ST Multiple Generics

  • H. Pylori Infection:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Prior Authorization: H. Pylori Infection:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Quantity Limit: 1 pack per 1 fill(s).
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