- Prior Authorization: PA_APPLIES
- Prior Authorization: Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Atopic Dermatitis (Eczema):
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 1 year(s)
Reauthorization Required: Yes
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