Western Health Advantage - All plan years |
Upneeq (oxymetazoline (PF)) |
Drugs for the Eye : Drugs for the Eye |
- PA_APPLIES
- Prior Authorization: Adjunctive Rheumatoid Arthritis:
Documented Diagnosis: Yes
Infantile Spasm: Documented Diagnosis: Yes
Age Requirement: < 2
Duration: 3 Month(s)
Reauthorization Required: Yes
Multiple Sclerosis Exacerbation: Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 week(s)
Nephrotic Syndrome: Documented Diagnosis: Yes
Age Requirement: > 2
Duration: 3 Month(s)
Reauthorization Required: Yes
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