| Anthem Blue Cross (HMO, PPO, EPO) |
| Ogivri (trastuzumab-dkst) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Prior Authorization: Behcet's Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
Psoriasis (PsO), Psoriatic Arthritis (PsA):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
|