| Health Net |
| Humira Pen-Pediatric UC Start (adalimumab) |
| Drugs for the Stomach : Drugs for Inflammatory Bowel Disease |
- Ulcerative Colitis (UC):
Age Requirement: >= 5
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Gastroenterologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
TB Test required: No
- Prior Authorization: Ulcerative Colitis (UC):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 5
Duration: 1 plan year
Reauthorization Required: Yes
- -Must use AcariaHealth Specialty Rx
- Step Therapy: Ulcerative Colitis (UC):
ST Single Generic
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