- Assisted Reproductive Technology (ART):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Zero Copay; $0 copay for members age 19 and older, otherwise not covered;
- PA_APPLIES
- Step Therapy: Psychiatry: Schizophrenia:
ST Single Generic
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