UnitedHealthcare
Otezla Starter 10 Mg (4)-20 Mg (4)-30 Mg(19) DsPk (apremilast)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Prior Authorization: Behcet's Disease:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Psoriasis (PsO), Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 27 tablets per 1 year
  • Behcet's Disease:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Psoriasis (PsO):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Psoriatic Arthritis (PsA):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    TB Test required: No

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