- Quantity Limit: limit maximum 400 EA PER 365 day(s)
- Prior Authorization: Pulmonary Arterial Hypertension:
Duration: 12 Month(s)
- Pulmonary Arterial Hypertension:
Duration: 12 Month(s)
Specialist Required: Yes
- Step Therapy: Pulmonary Arterial Hypertension:
ST Multiple Generics
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