| Anthem Blue Cross (HMO, PPO, EPO) |
| Adcetris (brentuximab vedotin) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 2 EA PER 30 day(s)
- QL (30 per Rx);
- Melanoma (MEL):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 1 ML PER 30 day(s)
|