Anthem Blue Cross (HMO, PPO, EPO) |
Otezla (apremilast) |
Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Available only through Specialty Pharmacy;
- Prior Authorization: Age Requirement: >= 18
Duration: 12 Month(s)
- Step Therapy: Psoriasis (PsO):
ST Multiple Brands
- PA Applies
- Quantity Limit: 2 tablets per 1 day(s).
- Psoriasis (PsO):
Age Requirement: >= 18
Duration: 12 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: Yes
History of Plaque Psoriasis: N/A
Overall % of Body Surface For Initiation: 5
Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
Psoriasis Classification: Moderate-Severe
Sensitive Area BSA Percent override: Yes
Psoriatic Arthritis (PsA): Age Requirement: >= 18
Duration: 12 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: Yes
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