- Chronic Heart Failure (CHF):
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Cardiologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Chronic Kidney Disease: Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
- Prior Authorization: Chronic Heart Failure (CHF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Chronic Kidney Disease: Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
- Step Therapy: ST Single Brand
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