| UnitedHealthcare |
| Nuedexta (dextromethorphan-quinidine) |
| Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
- Pseudo-Bulbar Affect:
Duration: 3 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Pseudo-Bulbar Affect:
Documented Diagnosis: Yes
Duration: 3 Month(s)
Reauthorization Required: Yes
|