- Step Therapy: Erectile Dysfunction (ED):
ST Single Generic
- Prior Authorization: Erectile Dysfunction (ED):
Documented Diagnosis: Yes
Age Requirement: >= 18
Gender Requirement: Male
Duration: 6 Month(s)
Reauthorization Required: Yes
- Erectile Dysfunction (ED):
Age Requirement: >= 18
Duration: 6 Month(s)
Gender Requirement: Male
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
- Quantity Limit: limit maximum 0.20 EA PER 1 day(s)
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