| Anthem Blue Cross (HMO, PPO, EPO) |
| Kynmobi Titration Kit (apomorphine) |
| Drugs for the Nervous System : Drugs for Parkinson |
- Prior Authorization: Parkinson's Disease:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Parkinson's Disease:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Diagnosis Type(s): Advanced
Clinically documented acute, intermittent treatment of hypomobility "off" episodes: Yes
Concomitant Use of Max Tolerable Dose of levodopa + 1 selegiline,pramipexole,entacapone,rasagiline: No
Use as adjunct therapy: No
Requires concomitant anti-emetic agent: Yes
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