- Crohn's Disease (CD):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 24 month(s)
TB Test required: No
- Minimum Age: 6 Years; Maximum Age: N.A.;
- Prior Authorization: Antiviral: Hepatitis C (HCV):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 3
Duration: 24 week(s)
- Quantity Limit: limit maximum 30 day(s) supply
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