Prior Authorization Criteria and Guidelines
Adderall XR 5,10,15,20 30mg >50kg: 60mg can be opened up. 15,30mg and sprinkled. 50/50 delivery. ... Wellbutrin 75,100mg tid dosing, up to 300mg lowers sz threshold. Wellbutrin SR 100,150,200mg bid dosing, up to 400mg Wellbutrin Xl 150,300mg qd dosing, up to 450mg. ................
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