Health Net
Dojolvi (triheptanoin)
Drugs for Nutrition : Drugs for Nutrition
  • Neuromyelitis Optica Spectrum Disorder:
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Prior Authorization: PA_APPLIES
  • Prior Authorization: PA_APPLIES