Sharp Health Plan - All plan years
Seysara (sarecycline)
Drugs for the Skin : Drugs for the Skin
  • PA_APPLIES
  • Behcet's Disease:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Psoriasis (PsO):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 3
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Sensitive Area BSA Percent override: No

    Psoriatic Arthritis (PsA):
    Age Requirement: >= 18
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    TB Test required: No

  • Prior Authorization: PA_APPLIES
  • Quantity Limit: limit maximum 1 EA PER 30 day(s)
<< Return | Back to top