- Quantity Limit: 30 day supply per 1 fill(s).
- Anxiety:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Major Depressive Disorder:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
- Quantity Limit: 30 day supply per 1 fill(s).
- Prior Authorization: PA_APPLIES
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