- Zero Copay;
- Prior Authorization: Graft Versus Host Disease (GVHD), Immune Thrombocytopenic Purpura (ITP), Multiple Sclerosis (MS), Secondary Progressive Multiple Sclerosis:
Documented Diagnosis: Yes
Duration: 1 year(s)
Granulomatosis with Polyangiitis, Microscopic Polyangiitis (MPA): Documented Diagnosis: Yes
Age Requirement: >= 2
Duration: 1 year(s)
Myasthenia Gravis, Pemphigus Vulgaris, Rheumatoid Arthritis (RA): Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
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