Anthem Blue Cross (HMO, PPO, EPO)
Kazano (alogliptin-metformin)
Hormones : Drugs for Diabetes
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • CD-30 Mediated Peripheral T-Cell Lymphoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): CVS Specialty
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Cutaneous T-Cell Lymphomas:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Hodgkin Lymphoma (HL):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Systemic Anaplastic Large Cell Lymphoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
    Reauthorization Required: No
    Duration of Reauthorization: N/A