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pitolisant hclBlue Cross Blue Shield of Montana

dose exceeding quantity limit

Initial criteria

  • Requested quantity (dose) does NOT exceed program quantity limit OR
  • Requested quantity (dose) exceeds limit AND ONE of the following:
  • A. BOTH: (1) Requested agent does NOT have a maximum FDA labeled dose; AND (2) Support for therapy with higher dose OR
  • B. BOTH: (1) Requested dose does NOT exceed maximum FDA labeled dose; AND (2) Support for why lower quantity of higher strength not feasible OR
  • C. BOTH: (1) Requested dose exceeds maximum FDA labeled dose; AND (2) Support for therapy with higher dose for requested indication

Approval duration

12 months