Examples of Approved Indications in a sentence
Requires more than 200 units of insulin per day Age RestrictionsN/A Prescriber RestrictionsN/A Coverage DurationPlan Year Other CriteriaN/AIBRANCE DrugsIBRANCECovered UsesAll FDA Approved Indications not otherwise excluded from Part D Exclusion CriteriaN/A Required Medical Information1.
Pt has recurring lesions after surgical excision OR surgery is contraindicated or inappropriate Age RestrictionsN/A Prescriber RestrictionsDermatologist or Oncologist Coverage DurationPlan Year Other CriteriaN/AERLEADA DrugsERLEADACovered UsesAll FDA Approved Indications not otherwise excluded from Part D Exclusion CriteriaN/A Required Medical InformationMust meet at least ONE of the following:1.
An adult pt has undergone colonoscopy of the entire colon within the past 6 months or a pediatric pt has undergone a colonoscopy of the entire colon in the past 6 months if there has been unexplained blood in the stool Age RestrictionsN/A Prescriber RestrictionsGastroenterologist Coverage Duration Initial: 6 months, Reauth: Plan Year Other CriteriaN/AGAVRETO DrugsGAVRETOCovered UsesAll FDA Approved Indications not otherwise excluded from Part D Exclusion CriteriaN/A Required Medical Information1.
Previous use of two of topiramate, valproic acid, or clobazam Age Restrictions2 years of age or older Prescriber RestrictionsNeurologist or epileptologist Coverage DurationPlan Year Other CriteriaN/AFIRAZYR DrugsICATIBANT ACETATECovered UsesAll FDA Approved Indications not otherwise excluded from Part D Exclusion CriteriaN/A Required Medical Information1.
If request not for generic tobramycin: Previous trial on generic tobramycin Age RestrictionsN/A Prescriber RestrictionsPulmonologist or Infectious Disease Specialist Coverage DurationPlan Year Other CriteriaBvsD determinationDAURISMO DrugsDAURISMOCovered UsesAll FDA Approved Indications not otherwise excluded from Part D Exclusion CriteriaN/A Required Medical Information1.