- Step Therapy Applies
- Hemophilia A (Factor VIII):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Dosing Limit(s): N/A
Treatment Center Required: No
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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