Anthem: Syfovre Payer Policy

Created by C. Denise Burrell, Modified on Wed, 8 Jan at 1:50 PM by C. Denise Burrell

Anthem: Syfovre Payer Policy (Beta Access)

HCPCS code(s): J2781
Link to Policy: Yes - (Click here for full policy)
Step therapy required: Not Provided
Provider fax form: ❌ Not Yet Available in SamaCare
- To request the addition of this form to our database, please email us at Help@samacare.com, including a blank PDF version of the authorization form.
FDA-Approved Indications: Not Provided
Recommended Dose: Not Provided
Other Pertinent Information:
- Clinical Criteria
- Quantity Limits