UnitedHealthcare
Palforzia (160 MG Daily Dose) (peanut allergen powder-dnfp)
Biological Agents : Biological Agents
  • Prior Authorization: Peanut Allergy:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 4
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Peanut Allergy:
    Age Requirement: >= 4
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Quantity Limit: limit maximum 60 EA PER 13 day(s)