Health Net
Humira Pen-Pediatric UC Start (adalimumab)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • -Must use AcariaHealth Specialty Rx
  • Prior Authorization: Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 5
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Step Therapy: Ulcerative Colitis (UC):
    ST Single Generic

  • Ulcerative Colitis (UC):
    Age Requirement: >= 5
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Gastroenterologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    TB Test required: No

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