| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| methylphenidate HCl (methylphenidate HCl) |
| Drugs for the Nervous System : Drugs for Sleep Disorder |
- Quantity Limit: 6 tablets per 1 day(s).
- Quantity Limit: limit maximum 1 GM PER 30 day(s)
- Quantity Limit: limit maximum 50 ML PER 30 day(s)
- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
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