- Available through Specialty Pharmacy;
- PA Required
- Prior Authorization: Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
- Rheumatoid Arthritis (RA):
Duration: 1 year(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: Yes
- Quantity Limit: 30 day supply per 1 fill(s).
- Step Therapy: Rheumatoid Arthritis (RA):
ST Single Generic
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