- Quantity Limit: 1 capsule per 1 day(s).
- Prior Authorization: Multiple Myeloma:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
- Step Therapy: ST_APPLIES
- Prior Authorization: Immune Thrombocytopenic Purpura (ITP):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 1
Duration: 6 Month(s)
Reauthorization Required: Yes
Severe Aplastic Anemia:
Age Requirement: >= 2
Duration: 6 Month(s)
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