Health Net
Opdivo (nivolumab)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 4 capsules per 1 day(s).
  • Step Therapy Exists in PA
  • Ankylosing Spondylitis (AS), Crohn's Disease (CD), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No

    Nonradiographic Axial Spondyloarthritis:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Psoriasis (PsO):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Sensitive Area BSA Percent override: No

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