- Quantity Limit: 2 tablets per 1 day(s).
- Prior Authorization: Gaucher Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 4
Duration: 6 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- Prior Authorization: Psychiatry: Schizophrenia:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
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