| Anthem Blue Cross (HMO, PPO, EPO) |
| Yervoy (ipilimumab) |
| Drugs for Cancer : Drugs for Cancer |
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: PA Required
- Quantity Limit: 200 needles per 30 day(s).
- Step Therapy: Step Therapy Exists in PA
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