- PA Required
- Available through Specialty Pharmacy;
- Multiple Sclerosis (MS):
Duration: 3 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
- Prior Authorization: Multiple Sclerosis (MS):
Duration: 3 Month(s)
- Quantity Limit: 30 day supply per 1 fill(s).
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