- Step Therapy: Immune Thrombocytopenic Purpura (ITP), Myasthenia Gravis, Uveitis:
ST Multiple Generics
Rheumatoid Arthritis (RA):
ST Generic and Brand
- Chorea in Huntington's Disease:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: limit maximum 4 EA PER 28 day(s)
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