| Anthem Blue Cross (HMO, PPO, EPO) |
| Jentadueto (linagliptin-metformin) |
| Hormones : Drugs for Diabetes |
- Diabetes Type 2: Long Acting Insulin + Combo:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Supporting Documentation Requirements: 2 of Chart Notes;Medication History
- Step Therapy: Antiviral: Hepatitis C (HCV):
ST Single Brand
- Step Therapy: ST Multiple Generics
- Prior Authorization: PA_APPLIES
|