- Prior Authorization: Amyotrophic Lateral Sclerosis (ALS):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Sickle Cell Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 12
Duration: 6 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Pain Narcotic: Opioid:
Documented Diagnosis: Yes
Duration: 1 Month(s)
- Prior Authorization: PA Required
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