Anthem Blue Cross (HMO, PPO, EPO)
Lupron Depot-Ped (3-Month) (leuprolide (pediatric 3 month))
Hormones : Drugs for Women
  • Step Therapy: ST_APPLIES
  • Derm: Acne Vulgaris:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Limited to non-cosmetic use: No

  • Prior Authorization: Soft Tissue Sarcoma:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Medical Benefit May Apply
  • Orally administered anticancer medication.