- Graft Versus Host Disease (GVHD):
Age Requirement: >= 12
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Step Therapy: Graft Versus Host Disease (GVHD):
ST Multiple Generics
- Prior Authorization: Graft Versus Host Disease (GVHD):
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 1 tablet per day
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