Anthem Blue Cross (HMO, PPO, EPO) |
Imbruvica (ibrutinib) |
Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 2 boxes per 30 day(s).
- Step Therapy: ST_APPLIES
- Duchenne Muscular Dystrophy (DMD):
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Specialty Pharmacy is Required: Not Defined
- Quantity Limit: 2 tablets per 1 day(s).
- Paroxysmal Nocturnal Hemoglobinuria:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- ST Applies
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