UnitedHealthcare - 2014 to Present
Methylin (methylphenidate HCl)
Drugs for the Nervous System : Drugs for Sleep Disorder
  • Sickle Cell Disease:
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Appropriate Specialist;Sickle Cell Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Prior Authorization: Diabetic Medical Supplies:
    Documented Diagnosis: Yes
    Age Requirement: >= 21
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Growth Hormone Deficiency:
    Duration: 6 Month(s)
    Specialist Required: Yes
    Specialist Type(s): 1 of Endocrinologist;Pediatric Endocrinologist
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)
    Pediatric Growth Hormone Deficiency (GHD) Requirement(s): 3 of Diagnosis of Pediatric Growth Hormone Deficiency;Epiphyses is Open;Growth Velocity Required;Height Standard Deviation Score Required;History of Neonatal Hypoglycemia Required;Insulin Growth Factor Binding Protein-3 (IGFBP-3) Level Required;Insulin-like Growth Factor 1 (IGF-1/Somatomedin-C) Level Required
    Pediatric - GH Stimulation Test: = 2
    Pediatric - Pituitary Hormone Deficiency: >= 1
    Pediatric - Reauthorization Requirement(s): 2 of Increase in growth rate;Positive response to therapy
    Adult Growth Hormone Deficiency Requirement(s): 3 of Cannot be used for athletic performance enhancement;Diagnosis of Adult-onset Growth Hormone Deficiency (GHD);Diagnosis of Childhood-onset Growth Hormone Deficiency (GHD);Insulin-like Growth Factor 1 (IGF-1/Somatomedin-C) Level Required
    Adult - GHD Stimulation Test: >= 1
    Adult - Pituitary Hormone Deficiency: >= 3
    Adult - Duration of Initial Authorization: >= 6 month(s)
    Adult - Reauthorization Requirement(s): 3 of Cannot be used for athletic performance enhancement;Insulin-like Growth Factor 1 (IGF-1) Required;Positive response to therapy
    Adult - Duration of Reauthorization: >= 6 month(s)
    Documented Diagnosis of Other Approved Indications: 1 of AIDs/HIV Associated Wasting or Cachexia;Chronic Renal Insufficiency;Growth Failure in Children Born Small for Gestational Age (SGA);Idiopathic Short Stature (ISS);Noonan Syndrome;Prader-Willi Syndrome in Children (PWS);Short Bowel Syndrome (SBS);Short Stature Homeobox-Containing Gene (SHOX);Turner's Syndrome (TS)
    Documented Diagnosis: Yes

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