| Anthem Blue Cross (HMO, PPO, EPO) |
| Delzicol (mesalamine) |
| Drugs for the Stomach : Drugs for Inflammatory Bowel Disease |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Prior Authorization: Peanut Allergy:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 4
Duration: 6 Month(s)
Reauthorization Required: Yes
- Limited Access.
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