Anthem Blue Cross (HMO, PPO, EPO)
Gocovri (amantadine HCl)
Drugs for the Nervous System : Drugs for Parkinson
  • Prior Authorization: Parkinson's Disease:
    Duration: 1 year(s)

  • Step Therapy: Parkinson's Disease:
    ST Multiple Generics

  • Parkinson's Disease:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Clinically documented acute, intermittent treatment of hypomobility "off" episodes: No
    Concomitant Use of Max Tolerable Dose of levodopa + 1 selegiline,pramipexole,entacapone,rasagiline: No
    Use as adjunct therapy: No
    Requires concomitant anti-emetic agent: No

  • Quantity Limit: 2 capsules per 1 day(s).
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