Western Health Advantage
Duopa (carbidopa-levodopa)
Drugs for the Nervous System : Drugs for Parkinson
  • Step Therapy: ST_APPLIES
  • Ovarian Cancer:
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Unspecified
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 12 month(s)
    Drug Policy Based On: 1 of Micromedex;NCCN Guidelines
    Diagnosis Types: 1 of All medically accepted indications;All NCCN indications with evidence level of 2A or higher
    Supporting Documentation Requirements: Chart Notes

    Small Cell Lung Cancer:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    ECOG Score Requirement Included in Policy: N/A
    Diagnosis Types: 2 of Small Cell Lung Cancer;Unspecified

  • Prior Authorization: Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 30 day(s) supply