| Western Health Advantage |
| Dhivy (carbidopa-levodopa) |
| Drugs for the Nervous System : Drugs for Parkinson |
- Quantity Limit: limit maximum 2 EA PER 84 day(s)
- Prior Authorization: Idiopathic Pulmonary Fibrosis (IPF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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