| Western Health Advantage |
| Xywav (sodium,calcium,mag,pot oxybate) |
| Drugs for the Nervous System : Drugs for Sleep Disorder |
- Step Therapy Applies
- Available through Specialty Pharmacy;
- Quantity Limit: 30 day supply per 1 fill(s).
- Idiopathic Hypersomnia:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Neurologist;Psychiatrist;Sleep Disorders Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 year(s)
- Prior Authorization: Idiopathic Hypersomnia:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- PA Required
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