Anthem Blue Cross (HMO, PPO, EPO) |
teriparatide (teriparatide) |
Hormones : Drugs for Menopause and Bone Loss |
- Step Therapy: Ankylosing Spondylitis (AS), Crohn's Disease (CD), Psoriasis (PsO), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
ST Multiple Brands
Nonradiographic Axial Spondyloarthritis: ST Multiple Generics
- Quantity Limit: 5 capsules per 25 day(s).
- Hidradenitis Suppurativa (HS):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 24 month(s)
Psoriasis (PsO): Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 24 month(s)
TB Test required: No
History of Plaque Psoriasis: N/A
Overall % of Body Surface For Initiation: N/A
Overall % of Body Surface For Initiation With Sensitive Areas: N/A
Psoriasis Classification: Moderate-Severe
Sensitive Area BSA Percent override: No
Uveitis: Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): 1 of AllCare Plus Pharmacy;BriovaRx
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
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