- Prior Authorization: Adult Onset Stills Disease (AOSD), Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Cryopyrin-Associated Periodic Syndromes (CAPS): Duration: 12 Month(s)
Reauthorization Required: Yes
- Adult Onset Stills Disease (AOSD):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Cryopyrin-Associated Periodic Syndromes (CAPS): Duration: 12 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Rheumatoid Arthritis (RA): Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
TB Test required: No
- Step Therapy: Rheumatoid Arthritis (RA):
ST Multiple Brands
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