- ADHD:
Age Requirement: >= 4
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Osteoarthritis: OA of the Knee:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Orthopedic Specialist;Rheumatologist;Sports Medicine Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Elapsed Duration Since Previous Course of Therapy: 6 month(s)
- Prior Authorization: Antiviral: Hepatitis C (HCV):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 24 week(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
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