Sharp Health Plan
Evamist (estradiol)
Hormones : Drugs for Women
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • Prior Authorization: Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 plan year
    Reauthorization Required: Yes

    Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

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