- Quantity Limit: 4 tablets per 1 day(s).
- Prior Authorization: Ankylosing Spondylitis (AS), Crohn's Disease (CD), Psoriasis (PsO), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Duration: 1 year(s)
Nonradiographic Axial Spondyloarthritis:
Duration: 1 year(s)
- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 12 Month(s)
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