- Quantity Limit: 2 capsules per 1 day(s).
- Quantity Limit: 1 capsule per 1 day(s).
- Step Therapy: ST Required
- Prior Authorization: Migraine:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
Migraine Prevention: Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
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