- Step Therapy Applies
- Prior Authorization: Transplant Rejection Prophylaxis:
Medical Test Required: Yes
Duration: 1 plan year
Reauthorization Required: Yes
- Transplant Rejection Prophylaxis:
Duration: 1 plan year
Documented Diagnosis: No
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
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