Anthem Blue Cross (HMO, PPO, EPO) |
Adasuve (loxapine) |
Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Step Therapy Applies
- Bipolar:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Psychiatry: Schizophrenia: Age Requirement: > 17
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: No
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: No
- Prior Authorization: Bipolar:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
Psychiatry: Schizophrenia: Age Requirement: > 17
Duration: 12 Month(s)
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