| Western Health Advantage - All plan years |
| Cosentyx (300 MG Dose) (secukinumab) |
| Drugs for the Skin : Drugs for the Skin |
- Quantity Limit: limit maximum 90 EA PER 30 day(s)
- Prior Authorization: Osteoarthritis: OA of the Knee:
Duration: 1 year(s)
- Quantity Limit: 2 sachets per 1 day(s).
- Hemophilia A (Factor VIII):
Duration: 3 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: = 3 month(s)
Dosing Limit(s): Unspecified
Diagnosis Type(s): Mild
Diagnosis Treatments: Bleeding episodes
Treatment Center Required: No
Von Willebrand Disease:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Dosing Limit(s): N/A
Treatment Center Required: No
Dosing Limits Exist: No
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