Limited Coverage Drugs – Obeticholic Acid
Generic Name: |
obeticholic acid |
|
---|---|---|
Strength: |
5 mg, 10 mg |
|
Form: |
tablet |
Special Authority Criteria |
Approval Period |
---|---|
INTIAL
|
12 months |
RENEWAL The patient continues to benefit from treatment with obeticholic acid, as evidenced by:
|
12 months |
Practitioner Exemptions
- There are no practitioner exemptions.
Special Notes
- None.