UnitedHealthcare |
Firdapse (amifampridine phosphate) |
Drugs for the Nervous System : Drugs for Multiple Sclerosis |
- Quantity Limit: limit maximum 8 EA PER 31 day(s)
- Lambert-Eaton Myasthenic Syndrome (LEMS):
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Neurologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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