Western Health Advantage - All plan years
LDO Plus (lidocaine HCl)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Eosinophilic Esophagitis (EoE):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Reauthorization Required: Yes

  • Prior Authorization: Hereditary Angioedema (HAE):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 12 Month(s)

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