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
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