Sample Notes Page - CareFirst BlueCross BlueShield
Prescription Drug Detail

Brand Name
Brand Tier
Generic Name
Generic Tier
NEULASTA
 
(Tier 3)
 
Not
Available
Not
Available

Prior Authorization Required: Yes
Quantity Limit: No
Category: Blood\Blood modifiers
Maintenance Drug: No
Notes: This medication requires Prior Authorization. Please have your physician call 1-866-522-2486 before prescribing this medication.
Attachments: Neupogen_Neulasta_V1.pdf