- Step Therapy: ST Single Generic
- Crohn's Disease (CD):
Age Requirement: >= 18
Duration: 1 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Gastroenterologist
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: No
Ulcerative Colitis (UC): Duration: 1 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Gastroenterologist
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: No
- Prior Authorization: Crohn's Disease (CD):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 Month(s)
Ulcerative Colitis (UC): Documented Diagnosis: Yes
Duration: 1 Month(s)
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