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Psoriasis If no no further questions. Reference Number C9575-A / Effective Date 03/01/2017 4. Has the patient had an inadequate response to or is the patient not a candidate for a 3-month minimum trial of phototherapy e.g. Psoralens with UVA light PUVA OR UVB with coal tar or dithranol contraindication to all of the following 1 tablets and 2 intramuscular injections If yes clinical documentation must be submitted demonstrating response to previous therapies. Pharmacy Prior Authorization AETNA...
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