- Prior Authorization: Pemphigus Vulgaris:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
PID: Immune Globulin:
Duration: 6 Month(s)
- Preventive Drug: Zero copay.
- Step Therapy: Derm: Acne Vulgaris:
ST Single Generic
- PA Applies
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