| Health Net |
| Quillivant XR (methylphenidate HCl) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- Quantity Limit: limit maximum 12 ML PER 1 day(s)
- ADHD:
Age Requirement: >= 6
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Step Therapy: ADHD:
ST Multiple Generics
- Prior Authorization: ADHD:
Documented Diagnosis: Yes
Age Requirement: >= 6
Duration: 1 plan year
Reauthorization Required: Yes
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