- Minimum Age: 10 Years; Maximum Age: N.A.;
- Quantity Limit: limit maximum 6 EA PER 365 day(s)
- Prior Authorization: Asthma (injectable), Asthma OCS Dependent:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 6
Duration: 6 Month(s)
Reauthorization Required: Yes
Nasal Polyposis:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 1.74 GM PER 1 day(s)
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