- Preferred agent for Psoriasis and Psoriatic Arthritis
- Prior Authorization: PA Applies
- Quantity Limit: limit maximum 60 EA PER 30 day(s)
- 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
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