- Step Therapy Applies
- Uterine Fibroids:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Medical Test Required: Yes
Specialist Type(s): Gynecologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Diagnosis Requirement(s): Uterine leiomyomata
Documented Diagnosis: Yes
- Prior Authorization: Uterine Fibroids:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
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