- Step Therapy Applies
- Tumor-induced osteomalacia (TIO):
Age Requirement: >= 2
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Endocrinologist;Metabolic Specialist
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
X-linked hypophosphatemia (XLH): Age Requirement: >= 1
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Endocrinologist;Metabolic Specialist
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
- Prior Authorization: Tumor-induced osteomalacia (TIO):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 2
Duration: 6 Month(s)
Reauthorization Required: Yes
X-linked hypophosphatemia (XLH): Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 1
Duration: 6 Month(s)
Reauthorization Required: Yes
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