| Kaiser Foundation Health Plan Northern California |
| Tavneos (avacopan) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Granulomatosis with Polyangiitis:
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Microscopic Polyangiitis (MPA):
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: No
Medical Test Required: No
Specialist Type(s): Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Granulomatosis with Polyangiitis:
ST Single Generic
Microscopic Polyangiitis (MPA):
Step Therapy Applies
- Prior Authorization: Granulomatosis with Polyangiitis:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Microscopic Polyangiitis (MPA):
Duration: 12 Month(s)
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