- Available only through Specialty Pharmacy;
- Erectile Dysfunction (ED):
Age Requirement: >= 18
Duration: 6 Month(s)
Gender Requirement: Male
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
- Quantity Limit: 200 syringes per 30 day(s).
- ST Applies
- Quantity Limit: 1 kit per 365 day(s).
|