| Anthem Blue Cross (HMO, PPO, EPO) |
| Endari (glutamine (sickle cell)) |
| Drugs for the Stomach : Drugs for the Stomach |
- Sickle Cell Disease:
Age Requirement: >= 5
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Sickle Cell Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 5
Duration: 1 year(s)
|