| HealthNet - All plan years |
| Xeljanz XR (tofacitinib) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Prior Authorization: Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
- PA_APPLIES
- Quantity Limit: 30 day supply per 1 fill(s).
- Quantity Limit: 30 day supply per 1 fill(s).
- Prior Authorization: PA_APPLIES
- Prior Authorization: PA Required
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