Limited Coverage Drugs - Abatacept

Generic Name / Strength / Form
abatacept

Criteria Approval Period
1. Treatment of Rheumatoid Arthritis according to established criteria* as prescribed by a rheumatologist First approval: 6 months
Renewal: 1 year

Practitioner Exemptions

  • None

Special Notes

  • None

Special Authority Request Forms

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