- Prior Authorization: Short Bowel Syndrome:
Documented Diagnosis: Yes
Age Requirement: >= 1
Duration: 12 Month(s)
Reauthorization Required: Yes
- Step Therapy: Short Bowel Syndrome:
ST Single Brand
- Short Bowel Syndrome:
Age Requirement: >= 1
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Gastroenterologist
Reauthorization Required: Yes
Duration of Reauthorization: >= 12 month(s)
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