| Sharp Health Plan - All plan years |
| Quillivant XR (methylphenidate HCl) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- Quantity Limit: limit maximum 12 mL PER 28 day(s)
- ST_APPLIES
- Prior Authorization: PA_APPLIES
- Bone Loss Treatments:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Diagnosis Types: 1 of Bone metastases from solid tumors;Hypercalcemia defined as albumin-corrected serum Calcium >12.5mg/dl;Hypercalcemia of malignancy refractory to bisphosphonate therapy;Patients with Multiple Myeloma;Unresectable Giant cell tumor of the bone
Supporting Documentation Must Be Submitted: No
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