Anthem Blue Cross (HMO, PPO, EPO)
Demser (metyrosine)
Drugs for the Heart : Drugs for High Blood Pressure
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • Prior Authorization: Esophageal Cancer, Head and Neck Cancer, Hepatocellular Carcinoma, Hodgkin Lymphoma (HL), Kidney Cancer, Malignant Pleural Mesothelioma, Merkel Cell Carcinoma, Urothelial/Bladder Cancer, Uveal Melanoma:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Gastric Cancer:
    Duration: 1 year(s)

    Melanoma (MEL), NSCLC EGFR Mutated, NSCLC Systemic Therapy:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

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