| Western Health Advantage |
| Besremi (ropeginterferon alfa-2b-njft) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Assisted Reproductive Technology (ART):
Documented Diagnosis: Yes
Duration: 1 year(s)
- Prior Authorization: Neurology: Epilepsy:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- Prior Authorization: PA Required
|