- May be covered under Medical Benefit.
- Prior Authorization: Hidradenitis Suppurativa (HS):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 12
Duration: 1 year(s)
Reauthorization Required: Yes
Psoriasis (PsO):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 year(s)
Reauthorization Required: Yes
Uveitis:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Step Therapy: Atopic Dermatitis (Eczema), Ulcerative Colitis (UC):
ST Multiple Generics
Psoriatic Arthritis (PsA):
ST Single Generic
Rheumatoid Arthritis (RA):
ST Generic and Brand
- ST_APPLIES
- PA Required
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