- Step Therapy: Myasthenia Gravis:
ST Multiple Generics
Neuromyelitis Optica Spectrum Disorder:
ST Multiple Brands
- Myasthenia Gravis, Neuromyelitis Optica Spectrum Disorder:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Neurologist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Paroxysmal Nocturnal Hemoglobinuria:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- Prior Authorization: Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
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