UnitedHealthcare - 2014 to Present
Siliq (brodalumab)
Drugs for the Skin : Drugs for the Skin
  • Glaucoma:
    Age Requirement: >= 17
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Supporting Documentation Requirements: Chart Notes
    Documented Diagnosis: Yes

  • QL (30 per Rx);
  • Quantity Limit: 2 units per 1 day(s).
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