Anthem Blue Cross and Blue Shield Virginia prior authorization Q4074

Anthem Blue Cross and Blue Shield Virginia prior authorization for Q4074: Iloprost, Inhalation Solution, Fda-Approved Final Product, Non-Compounded, Administered Through Dme, Unit Dose Form, Up

Code: Q4074
Description: Iloprost, Inhalation Solution, Fda-Approved Final Product, Non-Compounded, Administered Through Dme, Unit Dose Form, Up
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 75 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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