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Ivermectin Tablet Prior Authorization Criteria - Medicare Part D
Prior Authorization Criteria for Approval
Ivermectin tablets will be approved when BOTH of the following are met:
- The patient has an FDA labeled indication or an indication that is supported in CMS approved compendia for the requested medication AND
- The requested dose is within FDA labeled dosing or supported in CMS approved compendia dosing for the requested indication
Length of Approval: 4 months
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