| Anthem Blue Cross (HMO, PPO, EPO) |
| Bepreve (bepotastine besilate) |
| Drugs for the Eye : Drugs for Itchy Eye |
- Quantity Limit: limit maximum 5 mL PER 30 day(s)
- Prior Authorization: Ophthalmic: Allergic Conjunctivitis:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Step Therapy: Ophthalmic: Allergic Conjunctivitis:
ST Multiple Generics
- Ophthalmic: Allergic Conjunctivitis:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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