Anthem Blue Cross (HMO, PPO, EPO)
Lupron Depot-Ped (1-Month) (leuprolide)
Hormones : Drugs for Women
  • 1;
  • Quantity Limit: limit maximum 2 EA PER 1 day(s)
  • Quantity Limit: limit maximum 1 EA PER 1 day(s)
  • Zero Copay;
  • Prior Authorization: Hemophilia A (Factor VIII):
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes