| Anthem Blue Cross (HMO, PPO, EPO) |
| Remeron SolTab (mirtazapine) |
| Drugs for the Nervous System : Drugs for Depression |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Myelodysplastic Syndrome:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
|