- Erectile Dysfunction (ED):
Age Requirement: >= 18
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Step Therapy: Erectile Dysfunction (ED):
ST Single Generic
- Prior Authorization: Erectile Dysfunction (ED):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
|