Skip to main content

Call the helpline at 800-987-7767, option 5, and talk to choice counselors to change your SoonerSelect health plan!

Arthritis Medications

PHARM-13 Statement of Medical Necessity for Quantity Limits Override.

Antiviral Drugs

Drugs

Quantity Limits

Arava (Leflunomide) 10mg and 20mg Tablets 

 30 Tablets per 30 Days
Enbrel (Etanercept) 25mg Sub-Q Kit  8 vials per 30 Days
Enbrel (Etanercept) 25mg/0.5ml Sub-Q Disposable Syringe  4.08 mls per 28 Days
Enbrel (Etanercept) 50mg/ml Sub-Q Disposable Syringe  7.84 mls per 28 Days

Enbrel (Etanercept) 50mg/ml Sub-Q Pen Injector 

 7.84 mls per 28 Days
Flector (Diclofenac Epolamine) 1.3% Topical Adhesive Patch  30 Patches per 15 Days

Humira (Adalimumab) Sub-Q Kit 

20mg/0.4ml Kit - 4 Kits per 28 Days                            40mg/0.8ml Kit - 4 Kits per 28 Days                             40mg/0.8ml Pen Kits - 6 Kits per 42 Days                      
Kineret (Anakinra) Sub-Q 100mg/0.67 ml Disposable Syringe  18.76 mls per 28 Days
Simponi (Golimumab) Sub-Q 50mg/0.5ml Syringe or Pen 1 Syringe or Injector Pen per 30 Days

Uloric (Febuxostat) 40mg and 80mg Tablets 

 30 Tablets per 30 Days
Last Modified on Nov 17, 2020
Back to Top
Back to top

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

Contact Us

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.