Anthem Blue Cross (HMO, PPO, EPO)
diclofenac submicronized (diclofenac submicronized)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • Step Therapy: ST_APPLIES
  • May be covered under Medical Benefit.
  • Psoriasis (PsO):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: Yes
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 5
    Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: Yes

  • COPD (oral):
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    COPD associated with chronic bronchitis: No
    History of COPD exacerbation: No
    Documented Diagnosis: Yes