- Parkinson's Disease:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Neurologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Diagnosis Type(s): Unspecified
Clinically documented acute, intermittent treatment of hypomobility "off" episodes: Yes
Concomitant Use of Max Tolerable Dose of levodopa + 1 selegiline,pramipexole,entacapone,rasagiline: No
Use as adjunct therapy: No
Requires concomitant anti-emetic agent: No
Supporting Documentation Requirements: Chart Notes
- Prior Authorization: Parkinson's Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
- Step Therapy: Parkinson's Disease:
ST Multiple Generics
|