- Zero Copay;
- Step Therapy: ST Multiple Brands
- Multiple Sclerosis (MS):
Duration: 2 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 2 month(s)
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
Secondary Progressive Multiple Sclerosis:
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Neurologist
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
- Quantity Limit: limit maximum 300 EA PER 30 day(s)
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