- Step Therapy: Adult Onset Stills Disease (AOSD), Gouty Arthritis:
ST Multiple Generics
Rheumatoid Arthritis (RA): ST Multiple Brands
- Adult Onset Stills Disease (AOSD):
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Appropriate Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Cryopyrin-Associated Periodic Syndromes (CAPS): Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: No
Medical Test Required: No
Specialist Type(s): Rheumatologist
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
Gouty Arthritis: Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Appropriate Specialist
Reauthorization Required: Yes
Duration of Reauthorization: <= 12 month(s)
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
- Prior Authorization: Adult Onset Stills Disease (AOSD):
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
Cryopyrin-Associated Periodic Syndromes (CAPS): Duration: 6 Month(s)
Reauthorization Required: Yes
Gouty Arthritis: Documented Diagnosis: Yes
Medical Test Required: Yes
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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