| UnitedHealthcare |
| sodium phenylbutyrate (sodium phenylbutyrate) |
| Drugs that Alter Metabolism : Drugs that Alter Metabolism |
- Urea Cycle Disorder:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Urea Cycle Disorder:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
|