CNS STIMULANTS - DEXMETHYLPHENIDATE
| Covered Uses: | All FDA approved indications not otherwise excluded from Part D. |
| Exclusion Criteria: | |
| Required Medical Info: | Coverage for ADD/ADHD is provided in situations in which the diagnosis of ADD/ADHD has been confirmed using established criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) based ADHD rating scales such as Conners Comprehensive Behavior rating scale or ADHD rating scale IV or other criteria deemed appropriate by the prescriber. |
| Age Restrictions: | |
| Prescriber Restrictions: | |
| Coverage Duration: | 12 months |
| Other Criteria: | |
| Excluded Drug Criteria: |
Last Modified on 01/14/2013