- Pain Narcotic: Opioid:
Age Requirement: >= 18
Duration: 3 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: >= 3 month(s)
Diagnosis Type(s): Chronic Pain
Used for Cancer Patients: No
Around-The-Clock Analgesic Required: Yes
Morphine Equivalent Dose (MED) Limit: N/A
Morphine Equivalent Dose (MED) Required: No
- Prior Authorization: Pain Narcotic: Opioid:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
Reauthorization Required: Yes
|