Limited Coverage Drugs - Desmopressin

Generic Name / Strength / Form

desmopressin oral 0.1mg, 0.2mg tablet

desmopressin oral 60mcg, 120mcg, 240mcg disintegrating tablet

Special Authority Criteria

Approval Period

Treatment of diabetes insipidus. Indefinite

Practitioner Exemptions

  • No practitioner exceptions

Special Notes

  • Desmopressin oral will not be available as a benefit for the indication of nocturnal enuresis

Special Authority Request Form(s)