Anthem Blue Cross (HMO, PPO, EPO)
Perjeta (pertuzumab)
Drugs for Cancer : Drugs for Cancer
  • PA Applies
  • Step Therapy: ST_APPLIES
  • Hereditary Angioedema (HAE):
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Allergist;Immunologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Type(s): Treatment of Acute HAE Attacks
    HAE Type: Unspecified
    History of Moderate or Severe Attacks: No

  • PA Required
<< Return | Back to top