- Quantity Limit: 1 capsule per 1 day(s).
- Prior Authorization: Migraine:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
Reauthorization Required: Yes
Migraine Prevention:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
- Prior Authorization: Migraine:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Limited Access. Must use AcariaHealth Specialty Rx. Anti-Cancer:Maximum $200 copayment per State Law.
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