UnitedHealthcare
Humira Pen-Ps/UV/Adol HS Start (adalimumab)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Hidradenitis Suppurativa (HS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)

    Psoriasis (PsO):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    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
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Uveitis:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): 1 of AllCare Plus Pharmacy;BriovaRx
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Prior Authorization: Hidradenitis Suppurativa (HS), Psoriasis (PsO):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Uveitis:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)

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