- Quantity Limit: 30 day supply per 1 fill(s).
- Duchenne Muscular Dystrophy (DMD):
Age Requirement: >= 2
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Specialty Pharmacy is Required: Not Defined
- Prior Authorization: PA Required
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