| Anthem Blue Cross (HMO, PPO, EPO) |
| Viibryd Starter Pack (vilazodone) |
| Drugs for the Nervous System : Drugs for Depression |
- Quantity Limit: 1 dose pack per 365 day(s).
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;- Anxiety:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Major Depressive Disorder:
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: No
Documented Diagnosis: No
- Step Therapy: Anxiety:
ST Multiple Generics
- Prior Authorization: Anxiety:
Duration: 1 year(s)
- ST Applies
|