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;