Sutter Health Plus

Diacomit (stiripentol)

Drugs for the Nervous System : Drugs for Seizures /Personality Disorder/Nerve Pain

Quantity Limit: 4 pens per 28 day(s).
Quantity Limit: limit maximum 60 GM PER 30 day(s)
ST_APPLIES
Prior Authorization: Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes