| Health Net |
| Firdapse (amifampridine phosphate) |
| Drugs for Nerves and Muscles : Drugs for Nerves and Muscles |
- Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Lambert-Eaton Myasthenic Syndrome (LEMS):
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Neurologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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