| Anthem Blue Cross (HMO, PPO, EPO) |
| Firdapse (amifampridine phosphate) |
| Drugs for the Nervous System : Drugs for Multiple Sclerosis |
- Lambert-Eaton Myasthenic Syndrome (LEMS):
Duration: 3 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialty Pharmacy Provider(s): 1 of Accredo Health Group, Inc.;Apothecary By Design;Circle Care;The Pharmacy at Maine Medical Center
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 3 Month(s)
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