| UnitedHealthcare |
| Delzicol (Cpdr) (mesalamine) |
| Drugs for the Stomach : Drugs for Inflammatory Bowel Disease |
- Step Therapy Applies
- Prior Authorization: Gastro: Ulcerative Colitis:
PA Applies
- Gastro: Ulcerative Colitis:
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
TF of 5ASA product and prednisone: No
TF of 5ASA product: No
|