Anthem Blue Cross (HMO, PPO, EPO)
Lupron Depot (6-Month) (leuprolide (6 month))
Drugs for Cancer : Drugs for Cancer
  • Step Therapy: ST_APPLIES
  • Quantity Limit: 1 fill per 180 day(s).
  • Quantity Limit: 2 units per 1 day(s).
  • PA Applies
  • Pain Narcotic: Opioid:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: No
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No