| Western Health Advantage - All plan years |
| Siliq (brodalumab) |
| Drugs for the Skin : Drugs for the Skin |
- Prior Authorization: Chronic Lymphocytic Leukemia:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- Subject to initial 7-day limit;
- Quantity Limit: 2 units per 1 day(s).
- Quantity Limit: 204 strips per 30 day(s).
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