- Prior Authorization: Adult Onset Stills Disease (AOSD), Cryopyrin-Associated Periodic Syndromes (CAPS), Gouty Arthritis:
Duration: 1 year(s)
Reauthorization Required: Yes
Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Duration: 1 year(s)
- Adult Onset Stills Disease (AOSD), Cryopyrin-Associated Periodic Syndromes (CAPS), Gouty Arthritis:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Rheumatoid Arthritis (RA):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: No
- Step Therapy: Adult Onset Stills Disease (AOSD), Gouty Arthritis, Rheumatoid Arthritis (RA):
ST Multiple Generics
Cryopyrin-Associated Periodic Syndromes (CAPS):
ST Multiple Brands
- PA Applies
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;- Quantity Limit: 1 syringe per 1 day(s).
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