- Prior Authorization: Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Limited Access. Must use AcariaHealth Specialty Rx
- Rheumatoid Arthritis (RA):
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Rheumatologist
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
TB Test required: No
- Quantity Limit: 0.082 ml daily
- Step Therapy: Rheumatoid Arthritis (RA):
ST Multiple Brands
|