- Step Therapy: ST Multiple Generics
- Prior Authorization: Adjunctive Rheumatoid Arthritis, Nephrotic Syndrome:
Documented Diagnosis: Yes
Duration: 1 year(s)
Multiple Sclerosis Exacerbation: Duration: 1 year(s)
- Adjunctive Rheumatoid Arthritis, Nephrotic Syndrome:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Multiple Sclerosis Exacerbation: Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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