Skip to content
The Policy VaultThe Policy Vault

Ravicti — Medica

urea cycle disorders (UCDs)

Preferred products

  • generic sodium phenylbutyrate (tablets or powder)
  • Pheburane

Initial criteria

  • Patient meets the standard Metabolic Disorders – Phenylbutyrate Products Prior Authorization Policy criteria
  • Patient has tried one Preferred Product (generic sodium phenylbutyrate [tablets or powder] or Pheburane)