- ADHD:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: ADHD:
Documented Diagnosis: Yes
Duration: 12 Month(s)
- Quantity Limit: Maximum quantity of 31 per 31 Day(s). Maximum quantity 1 tablet per day.
- Prior authorization required. Member should try alternative(s) before submitting a prior authorization. If approved, covered at appropriate tier under the member's pharmacy benefit.
- Step Therapy: ADHD:
ST Multiple Generics
- 20210128_Launch Project_VM
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