| Anthem Blue Cross (HMO, PPO, EPO) |
| Lupron Depot (3-Month) (leuprolide (3 month)) |
| Hormones : Drugs for Women |
- Quantity Limit: 4 capsules per 1 day(s).
- PA Applies
- Step Therapy: Derm: Rosacea:
Step Applies
- Prior Authorization: PA_APPLIES
- Zero Copay may apply.
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