UnitedHealthcare - 2014 to Present
Xartemis XR (oxycodone-acetaminophen)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Quantity Limit: limit maximum 0.60 EA PER 1 day(s)
  • Prior Authorization: Myelodysplastic Syndrome:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)

  • May be covered under Medical Benefit.