- Prior Authorization: Bone Loss Treatments:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Major Depressive Disorder:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
Psychiatry: Schizophrenia:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
- Step Therapy: ST Single Generic
- Step Therapy: Diabetes Type 2: DPP4 + Combo:
ST Generic and Brand
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