- Available through Specialty Pharmacy;
- Ulcerative Colitis (UC):
Duration: 1 year(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Gastroenterologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 year(s)
TB Test required: No
- Prior Authorization: Ulcerative Colitis (UC):
Documented Diagnosis: Yes
Duration: 1 year(s)
Reauthorization Required: Yes
- Quantity Limit: 30 day supply per 1 fill(s).
- PA Required
- Step Therapy: Ulcerative Colitis (UC):
ST Multiple Generics
|