| Anthem Blue Cross (HMO, PPO, EPO) |
| Taltz (ixekizumab) |
| Drugs for the Skin : Drugs for the Skin |
- Prior Authorization: Psoriasis (PsO):
Age Requirement: >= 18
Duration: 12 Month(s)
- Psoriasis (PsO):
Age Requirement: >= 18
Duration: 12 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: Yes
History of Plaque Psoriasis: N/A
Overall % of Body Surface For Initiation: 10
Overall % of Body Surface For Initiation With Sensitive Areas: N/A
Psoriasis Classification: Moderate-Severe
Sensitive Area BSA Percent override: No
- Quantity Limit: 1 auto-injector per 28 day(s).
- Step Therapy: Psoriasis (PsO):
ST Multiple Brands
- PA Applies
- Available only through Specialty Pharmacy; Limited access;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
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