Health Net
Ruzurgi (amifampridine)
Drugs for the Nervous System : Drugs for Multiple Sclerosis
  • Lambert-Eaton Myasthenic Syndrome (LEMS):
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Quantity Limit: limit maximum 10 EA PER 1 day(s)
  • Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Reauthorization Required: Yes