- Step Therapy Applies
- Quantity Limit: Maximum quantity 1 capsule per day
- Psychiatry: Schizophrenia:
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
- Prior Authorization: Psychiatry: Schizophrenia:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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