Sutter Health Plus
Intrarosa (prasterone (dhea))
Hormones : Drugs for Women
  • 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