Western Health Advantage
Orilissa (elagolix)
Hormones : Drugs for Women
  • Prior Authorization: PA Required
  • Prior Authorization: Adult Onset Stills Disease (AOSD):
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

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