- Prior Authorization: Ankylosing Spondylitis (AS), Psoriasis (PsO), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
Crohn's Disease (CD): Documented Diagnosis: Yes
Age Requirement: >= 6
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 4 EA PER 30 day(s)
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