- May be covered under Medical Benefit.
- Prior Authorization: Ankylosing Spondylitis (AS), Crohn's Disease (CD), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
Psoriasis (PsO):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Diabetes Type 2: Short Acting Insulin (Meal-time):
Documented Diagnosis: Yes
Duration: 1 year(s)
- 1;
- Prior Authorization: Hepatocellular Carcinoma, Kidney Cancer, Malignant Pleural Mesothelioma, NSCLC Systemic Therapy, Uveal Melanoma:
Documented Diagnosis: Yes
Duration: 1 year(s)
Melanoma (MEL):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
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