| Anthem Blue Cross (HMO, PPO, EPO) |
| Dutoprol (metoprolol su-hydrochlorothiaz) |
| Drugs for the Heart : Drugs for High Blood Pressure |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Prior Authorization: Pompe Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
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