Anthem Blue Cross (HMO, PPO, EPO)
Bavencio (avelumab)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 30 day supply per 1 fill(s).
  • Multiple Sclerosis (MS):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Patients Cardiac Medical History Required: No
    Concomitant use of other MS medication: No

  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 2 fills per 365 day(s).
  • Ankylosing Spondylitis (AS), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

    Psoriatic Arthritis (PsA):
    Age Requirement: >= 18
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes