- Spinal Muscular Atrophy (SMA):
Age Requirement: >= 1
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Neurologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: limit maximum 1,200 ML PER 180 day(s)
- Prior Authorization: Spinal Muscular Atrophy (SMA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 1
Duration: 12 Month(s)
Reauthorization Required: Yes
|