- Step Therapy Applies
- Sickle Cell Disease:
Age Requirement: >= 5
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Prior Authorization: Sickle Cell Disease:
Documented Diagnosis: Yes
Age Requirement: >= 5
Duration: 1 plan year
Reauthorization Required: Yes
|