Anthem Blue Cross (HMO, PPO, EPO) |
Evrysdi (risdiplam) |
Drugs for Nerves and Muscles : Drugs for Nerves and Muscles |
For FAX form click HERE Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites: Log in to Surescripts Log in to CoverMyMeds; For details on drug coverage click HERE;
- Spinal Muscular Atrophy (SMA):
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- Quantity Limit: limit maximum 5 mL PER 1 day(s)
- Prior Authorization: Spinal Muscular Atrophy (SMA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- PA Applies
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