| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Xeljanz XR (tofacitinib) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Assisted Reproductive Technology (ART):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
Reauthorization Required: No
Duration of Reauthorization: N/A
- 1;
- Quantity Limit: limit maximum 24 EA PER 30 day(s)
- Osteoarthritis: OA of the Knee:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Orthopedic Specialist;Rheumatologist;Sports Medicine Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Elapsed Duration Since Previous Course of Therapy: 6 month(s)
- ST_APPLIES
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