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)