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)