Sutter Health Plus
Nolix (flurandrenolide)
Drugs for the Skin : Drugs for the Skin
  • Cluster Headache:
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Neurologist;Pain Management Specialist
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Ovarian Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: 1 of Clinical Pharmacology;NCCN Guidelines
    Diagnosis Types: 2 of Advanced disease;Advanced ovarian, fallopian tube or primary peritoneal cancers after 3 or more prior chemo regimens with HRD+ mutations by deleterious or suspected deleterious BRCA mutation or genomic instability and progression >6 months after response to the last platinum-based therapy;epithelial ovarian, fallopian tube, or primary peritoneal cancer;maintenance treatment after a complete or partial response to platinum-based chemotherapy;Recurrent disease
    Supporting Documentation Requirements: Homologous recombination deficiency (HRD) testing

  • Step Therapy: Ankylosing Spondylitis (AS), Hidradenitis Suppurativa (HS), Uveitis:
    ST Multiple Generics

    Crohn's Disease (CD), Juvenile Idiopathic Arthritis, Psoriasis (PsO), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
    ST Single Generic