- Step Therapy Applies
- Sickle Cell Disease:
Age Requirement: >= 5
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Sickle Cell Disease:
Documented Diagnosis: Yes
Age Requirement: >= 5
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 6 EA PER 1 day(s)
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