- Major Depressive Disorder:
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: No
Major Depressive Disorder with Suicidal Ideation : Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- ST_APPLIES
- Diabetic Medical Supplies:
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Prior Authorization: Idiopathic Hypersomnia, Narcolepsy Type 1, Narcolepsy Type 2:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 3 Month(s)
Reauthorization Required: Yes
Neurology: Narcolepsy: PA Applies
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