- Quantity Limit: limit maximum 4 EA PER 1 day(s)
- Quantity Limit: limit maximum 10 GM PER 1 day(s)
- Prior Authorization: Multiple Sclerosis (MS), Secondary Progressive Multiple Sclerosis:
Documented Diagnosis: Yes
Duration: 1 year(s)
Ulcerative Colitis (UC):
Documented Diagnosis: Yes
Age Requirement: >= 18
- Step Therapy: Asthma (injectable):
ST Multiple Generics
Nasal Polyposis:
ST Single Generic
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