- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Step Therapy: Multiple Sclerosis (MS):
ST Single Brand
- Multiple Sclerosis (MS):
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: <= 12 month(s)
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
Supporting Documentation Requirements: 2 of Chart Notes;Lab Tests
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