- Quantity Limit: 1 tablet per 1 day(s).
- ST_APPLIES
For FAX form click HERE Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites: Log in to Surescripts Log in to CoverMyMeds; For details on drug coverage click HEREFor details on quantity limit criteria click HERE Duration Limit- 7 days supply per fill; 14 days supply per 30 days; For details on the 7-day duration limit criteria click HEREFor details on morphine equivalent dose criteria click HERE ;
- May be covered under Medical Benefit.
- Prior Authorization: PA_APPLIES
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