- Quantity Limit: 200 syringes per 30 day(s).
- Prior Authorization: PA_APPLIES
- 1;
- Step Therapy: ADHD:
ST Single Generic
- Prior Authorization: Behcet's Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
Psoriasis (PsO), Psoriatic Arthritis (PsA): Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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