- Step Therapy Applies
- Major Depressive Disorder:
Age Requirement: >= 18
Duration: 3 Month(s)
Specialist Required: Yes
Medical Test Required: No
Specialist Type(s): Psychiatrist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Documented Diagnosis: Yes
Major Depressive Disorder with Suicidal Ideation :
Age Requirement: >= 18
Duration: 4 week(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Psychiatrist
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Major Depressive Disorder with Suicidal Ideation :
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 4 week(s)
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