- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Chronic Idiopathic Constipation:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Patient does not have known or suspected mechanical obstruction: No
Diagnosis of severe CIC: No
Duration Required for Patient to Have Symtoms of CIC: N/A
Patient has known or suspected mechanical obstruction: No
Symptoms > 3 months: No
Failure of 1 conventional laxative therapy: Yes
Failure of 2 conventional laxative therapies: No
Failure of 3 conventional laxative therapies: No
- Step Therapy: Chronic Idiopathic Constipation:
Step Applies
- Prior Authorization: Chronic Idiopathic Constipation:
PA Applies
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