| UnitedHealthcare |
| Follistim AQ 75 Unit/0.5 Ml Soln (follitropin beta) |
| Hormones : Drugs for Women |
- Prior Authorization: Hereditary Angioedema (HAE):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Anti-Cancer:Maximum $200 copayment per State Law.
|