Nuedexta
Defines prior authorization and quantity limit requirements for Nuedexta under the Pharmacy Benefit for Commercial/Exchange members; covers authorization criteria, approvals duration, and quantity limits.
Separated Commercial/Exchange vs MassHealth policies; no clinical updates as of 09/21/2022, effective 01/01/2023.
Coverage Summary
Coverage stance: covered_with_criteria for Nuedexta (dextromethorphan hydrobromide/quinidine sulfate). This policy applies to Commercial/Exchange members under the Pharmacy Benefit and defines prior authorization and quantity limit requirements for Nuedexta.