- Zero Copay;
- Psoriasis (PsO):
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
TB Test required: No
Sensitive Area BSA Percent override: No
Psoriatic Arthritis (PsA):
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
TB Test required: No
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- PA Required
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