Health Net
Rituxan Hycela (rituximab-hyaluronidase,human)
Drugs for Cancer : Drugs for Cancer
  • 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)