| Anthem Blue Cross (HMO, PPO, EPO) |
| Imlygic (talimogene laherparepvec) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 3 EA PER fill retail
- ADHD:
Age Requirement: >= 4
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
|