Anthem Blue Cross (HMO, PPO, EPO) |
acyclovir sodium (acyclovir sodium) |
Drugs for Infections : Drugs for Viral Infections |
- Prior Authorization: Cytomegalovirus (CMV):
Duration: 1 year(s)
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Cytomegalovirus (CMV):
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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