UnitedHealthcare - 2014 to Present |
Ocaliva (obeticholic acid) |
Drugs for the Liver : Drugs for the Liver |
- PA_APPLIES
- Quantity Limit: Limit 50gms per month;QL(1.7gm daily)
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Prior Authorization: Antiviral: Hepatitis C (HCV):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 3
Duration: 24 week(s)
|