Anthem Blue Cross (HMO, PPO, EPO) |
Elelyso (taliglucerase alfa) |
Drugs for Metabolic Disease : Drugs for Metabolic Disease |
- ST_APPLIES
- PA_APPLIES
- Prior Authorization: Bipolar:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
Psychiatry: Schizophrenia: Age Requirement: > 17
Duration: 12 Month(s)
- Erectile Dysfunction (ED):
Age Requirement: >= 18
Duration: 6 Month(s)
Gender Requirement: Male
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
|