- Prior Authorization: Post-herpetic Neuralgia:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Post-herpetic Neuralgia:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: (3 patches per day)
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