Limited coverage drugs – diphenoxylate HCl-atropine sulfate
Last updated on August 20, 2024
|
Generic name |
diphenoxylate HCI-atropine sulfate |
|---|---|
|
Strength |
2.5-0.025 mg |
|
Form |
tablet |
|
Special Authority criteria |
Approval period |
|---|---|
|
Treatment of diarrhea due to a specified chronic illness. |
Indefinite |
Practitioner exemptions
- None
Special notes
- Details regarding patient's condition are required