- Ankylosing Spondylitis (AS), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
TB Test required: Yes
Psoriatic Arthritis (PsA): Age Requirement: >= 18
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
TB Test required: Yes
- Prior Authorization: PA_APPLIES
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
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