| Anthem Blue Cross (HMO, PPO, EPO) |
| Wynzora (calcipotriene-betamethasone) |
| Drugs for the Skin : Drugs for the Skin |
- Prior Authorization: Topical Psoriasis:
PA Applies
- Quantity Limit: 420 grams per 28 day(s).
- Topical Psoriasis:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
- Step Therapy: Topical Psoriasis:
Step Applies
|