- Prior Authorization: Aggressive Systemic Mastocytosis (ASM):
Documented Diagnosis: Yes
Age Requirement: >= 5
Duration: 1 plan year
Reauthorization Required: Yes
Hepatitis B Treatment:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 3
Duration: 48 week(s)
Reauthorization Required: Yes
- Aggressive Systemic Mastocytosis (ASM):
Age Requirement: >= 5
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Hepatitis B Treatment:
Age Requirement: >= 3
Duration: 48 week(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Gastroenterologist;Hepatologist;Infectious Disease Specialist
Reauthorization Required: Yes
Duration of Reauthorization: <= 48 week(s)
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