Limited Coverage Drugs – Tofacitinib
Generic Name |
tofacitinib |
---|---|
Strength |
5 mg |
Form |
tablet |
Special Authority Criteria |
Approval Period |
---|---|
For the treatment of Rheumatoid Arthritis when:
|
First approval: 1 year
|
Practitioner Exemptions
- No practitioner exemptions.
Special Notes
- PharmaCare covers a maximum 30 days’ supply per fill.
Special Authority Request Form(s)
* Click on the Special Authority Form below for full criteria: