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
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