- Step Therapy: Neovascular (Wet) Age-Related Macular Degeneration (AMD):
ST Single Generic
- Prior Authorization: Neovascular (Wet) Age-Related Macular Degeneration (AMD):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Neovascular (Wet) Age-Related Macular Degeneration (AMD):
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
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