- Prior Authorization: Post-herpetic Neuralgia:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Post-herpetic Neuralgia:
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Step Therapy: Post-herpetic Neuralgia:
ST Multiple Generics
- Quantity Limit: limit maximum 3 EA PER 1 day(s)
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