- Neuromyelitis Optica Spectrum Disorder:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Preferred Limited Distribution Network
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Osteoporosis: Post Menopausal Women:
ST Single Brand
- Quantity Limit: limit maximum 60 GM PER 30 day(s)
- May be covered under Medical Benefit.
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