- Parkinson's Disease:
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Diagnosis Type(s): Unspecified
Clinically documented acute, intermittent treatment of hypomobility "off" episodes: Yes
Concomitant Use of Max Tolerable Dose of levodopa + 1 selegiline,pramipexole,entacapone,rasagiline: No
Use as adjunct therapy: Yes
Requires concomitant anti-emetic agent: No
- Step Therapy: Parkinson's Disease:
ST Multiple Generics
- Prior Authorization: Parkinson's Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
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