- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 2 Month(s)
Reauthorization Required: Yes
Secondary Progressive Multiple Sclerosis:
Documented Diagnosis: Yes
Reauthorization Required: Yes
- Prior Authorization: PA Required
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- Quantity Limit: 0.05 units per 1 day(s).
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