| UnitedHealthcare |
| Spravato (56 MG Dose) (esketamine) |
| Drugs for the Nervous System : Drugs for Depression |
- PA_APPLIES
- Prior Authorization: PA Required
- Quantity Limit: limit maximum 1 EA PER 1 day(s) limit maximum 91 day(s) supply
- Quantity Limit: 200 syringes per 30 day(s).
|