- Step Therapy Applies
- Quantity Limits Apply
- Cholestatic Liver Disease:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Hepatologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Cholestatic Liver Disease:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
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