Anthem Blue Cross (HMO, PPO, EPO)
Daliresp (roflumilast)
Drugs for the Lungs : Drugs for Asthma/COPD
  • Osteoporosis: Post Menopausal Women:
    Duration: 1 year(s)
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    History of Fracture Required: Required
    BMD T-score at neck, total hip, or lumbar spine: <= -3
    Self-Administration Allowed: No
    Multiple fractures required: Yes
    Documented Diagnosis: Yes

  • Prior Authorization: Multiple Myeloma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • PA Applies
  • Quantity Limit: 30 day supply per 1 fill(s).