Prior Authorization: Chronic Lymphocytic Leukemia, Diffuse Large B-Cell Lymphoma, Follicular Lymphoma (FL), Graft Versus Host Disease (GVHD), Granulomatosis with Polyangiitis, Marginal Zone Lymphoma, Microscopic Polyangiitis (MPA), Non Hodgkin Lymphoma (NHL), Pemphigus Vulgaris, Waldenstrom Macroglobulinemia:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes

Immune Thrombocytopenic Purpura (ITP):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes

Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes

Myasthenia Gravis, Uveitis:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes

Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes