| Anthem Blue Cross (HMO, PPO, EPO) |
| Vfend (voriconazole) |
| Drugs for Infections : Drugs for Fungus |
- Prior Authorization: Antifungal:
Documented Diagnosis: Yes
Duration: 6 Month(s)
- Antifungal:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 4 tablets per 1 day(s).
|