UnitedHealthcare
Firdapse (amifampridine phosphate)
Drugs for the Nervous System : Drugs for Multiple Sclerosis
  • Quantity Limit: limit maximum 8 EA PER 31 day(s)
  • Lambert-Eaton Myasthenic Syndrome (LEMS):
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Neurologist;Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

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