- COPD (oral):
Age Requirement: >= 18
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
COPD associated with chronic bronchitis: No
History of COPD exacerbation: No
Documented Diagnosis: Yes
- Step Therapy: Ankylosing Spondylitis (AS):
ST Multiple Generics
Juvenile Idiopathic Arthritis, Psoriasis (PsO), Rheumatoid Arthritis (RA):
ST Single Generic
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Duration: 1 plan year
Reauthorization Required: Yes
- Prior Authorization: PA_APPLIES
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