UnitedHealthcare - 2014 to Present |
Xyrem (sodium oxybate) |
Drugs for the Nervous System : Drugs for Sleep Disorder |
- May be covered under Medical Benefit.
- Hemophilia A (Factor VIII):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Dosing Limit(s): N/A
Treatment Center Required: No
- May be covered under Medical Benefit.
- PA Applies
- PA Applies
- Available only through Specialty Pharmacy;
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