Anthem Blue Cross and Blue Shield New Hampshire prior authorization Q4074

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for Q4074: Iloprost, inhalation solution, FDA- approved final product, noncompounded, administered through DME, unit dose form, up to 20 mcg

Code: Q4074
Description: Iloprost, inhalation solution, FDA- approved final product, noncompounded, administered through DME, unit dose form, up to 20 mcg
Source: New Hampshire Precertification List, Pg 254 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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