- Quantity Limit: limit maximum 3 EA PER fill retail
- Health Net Approved Indications and Usage Guidelines: 1. Diagnosis of chronic heart failure of NYHA (New York Heart Association) Class II-IV. AND 2. Prescribed by or in consultation with a Cardiologist. AND 3. Left ventricular ejection fraction less than 40%. Authorization Limit: Length of Benefit.
- Prior Authorization: Chemo-induced Nausea and Vomiting (CINV):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Day(s)
Reauthorization Required: Yes
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