| Anthem Blue Cross (HMO, PPO, EPO) |
| Nuedexta (dextromethorphan-quinidine) |
| Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Pseudo-Bulbar Affect:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 2 capsules per 1 day(s).
- Prior Authorization: Pseudo-Bulbar Affect:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
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