| Anthem Blue Cross (HMO, PPO, EPO) |
| Viibryd Starter Pack (vilazodone) |
| Drugs for the Nervous System : Drugs for Depression |
- Prior Authorization: PA_APPLIES
- Prior Authorization: Osteoarthritis: OA of the Knee:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- PA Applies
- Quantity Limit: limit maximum 204 EA PER 25 day(s)
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