Health Net
Opzelura (ruxolitinib)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy: Atopic Dermatitis (Eczema):
    ST Generic and Brand

  • Atopic Dermatitis (Eczema):
    Age Requirement: >= 12
    Duration: 8 week(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Allergist;Dermatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 8 week(s)
    Initial Authorization - POEM Values: N/A
    Initial Authorization - SCORAD Values: N/A
    Initial Authorization - EASI Values: N/A
    Initial Authorization - IGA Values: N/A
    Initial Authorization - PGA Values: N/A
    Initial Authorization - ISGA Values: N/A
    Initial Authorization - BSA Values: N/A
    Physician Attestation for Initiation Required: No
    Step Trial Length Period: Variable
    Reauthorization Assessment Required: None

  • Prior Authorization: Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 8 week(s)
    Reauthorization Required: Yes

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