- Prior authorization required. Member should try alternative(s) before submitting a prior authorization. If approved, covered at appropriate tier under the member's pharmacy benefit.
- Step Therapy: Gastro: IBS-C:
Step Applies
- Gastro: IBS-C:
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Duration of IBS Symptoms Required: N/A
No Known Mechanical GI Obstruction: No
Documented Diagnosis: Yes
Documented Symptoms >= 3 Months: No
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