Health Net
Humira Pen-CD/UC/HS Starter (adalimumab)
Drugs for the Stomach : Drugs for Inflammatory Bowel Disease
  • -Must use AcariaHealth Specialty Rx
  • Step Therapy: Crohn's Disease (CD), Ulcerative Colitis (UC):
    ST Single Generic

    Hidradenitis Suppurativa (HS):
    ST Multiple Generics

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

    Hidradenitis Suppurativa (HS):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 5
    Duration: 1 plan year
    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

    Hidradenitis Suppurativa (HS):
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Gastroenterologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Ulcerative Colitis (UC):
    Age Requirement: >= 5
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Gastroenterologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    TB Test required: No

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