Sumatriptan (imitrex) utilization management criteria

Bc bs nc.c om short term: 900 mg (tablet equiv*) per 30 days 9 tablets 18 tablets 36 tablets 4 kits (8 injections) 4 kits (8 injections) 9 devices 36 devices

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General references: 17. beckett b. headache disorder, in dipiro j (ed): pharmacotherapy: a pathophysiologic approach. stamford, simon & schuster, 1997;


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