- Quantity Limit: 30 day supply per 1 fill(s).
- Prior Authorization: Age Requirement: >= 18
Duration: 12 Month(s)
- Prior Authorization: EDS due to OSA, Idiopathic Hypersomnia:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Neurology: Narcolepsy:
PA Applies
- Quantity Limit: 1 tablet per 1 day(s).
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