Sutter Health Plus
Inrebic (fedratinib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Psoriasis (PsO):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 4
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 48 EA PER 25 day(s)
  • Central Precocious Puberty:
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Onset of Secondary Sexual Characteristics for Females: < 8 year(s)
    Onset of Secondary Sexual Characteristics for Males: < 9 year(s)
    Documented Diagnosis: Yes

  • Subject to initial 7-day limit, if age 19 or younger, subject to initial 3-day limit