| Anthem Blue Cross (HMO, PPO, EPO) |
| Fragmin (dalteparin (porcine)) |
| Drugs for the Blood : Drugs to Prevent Blood Clots |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Prior Authorization: Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- 1;
|