- May be covered under Medical Benefit.
- Prior Authorization: Atopic Dermatitis (Eczema):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Eosinophilic Esophagitis (EoE):
Documented Diagnosis: Yes
Age Requirement: >= 12
Reauthorization Required: Yes
- PA Applies
- PA_APPLIES
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