Health Net
Humira Pediatric Crohns Start (adalimumab)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Step Therapy: Crohn's Disease (CD):
    ST Single Generic

    Uveitis:
    ST Multiple Generics

  • Prior Authorization: Crohn's Disease (CD):
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Uveitis:
    Documented Diagnosis: Yes
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Crohn's Disease (CD):
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Gastroenterologist
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)
    TB Test required: No

    Uveitis:
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Ophthalmologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

  • -Must use AcariaHealth Specialty Rx
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