HealthNet - All plan years
Zofran (ondansetron HCl)
Drugs for the Stomach : Drugs for Vomiting and Nausea
  • Quantity Limit: Limit 4 per month;QL(0.15ea daily)
  • Prior Authorization: Narcolepsy Type 1, Narcolepsy Type 2:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 3 Month(s)
    Reauthorization Required: Yes

    Neurology: Narcolepsy:
    PA Applies
  • Step Therapy: ST_APPLIES
<< Return | Back to top