Anthem Blue Cross (HMO, PPO, EPO)
Valtoco 15 MG Dose (diazepam)
Drugs for the Nervous System : Drugs for Seizures /Personality Disorder/Nerve Pain
  • Quantity Limit: 10 blister packs per 30 day(s).
  • Prior Authorization: Cluster Seizure/Seizure Emergency:
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 1 year(s)

  • Cluster Seizure/Seizure Emergency:
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

<< Return | Back to top