Limited Coverage Drugs – Certolizumab for the treatment of Rheumatoid Arthritis

Generic Name

certolizumab

Strength

200 mg/mL
Form subcutaneous injection solution

Special Authority Criteria

Approval Period

Treatment of Rheumatoid Arthritis according to established criteria when prescribed by a rheumatologist 1 year

Practitioner Exemptions

  • None

Special Notes

  • None

Special Authority Request Form(s)

Click on the appropriate Special Authority Form below for full criteria.