- Step Therapy: Chronic Kidney Disease:
ST Single Brand
- Cholestatic Liver Disease:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Gastroenterologist;Hepatologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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