- Quantity Limit: limit maximum 4 ML PER 28 day(s)
- Prior Authorization: PA Required
- Quantity Limit: limit maximum 60 ML PER 30 day(s)
- Psychiatry: Schizophrenia:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
- Prior Authorization: PA Applies
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