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Trial of at maximum tolerated doses or at a maximum tolerated dose If yes list medication s tried or a tricyclic antidepressant i.e. or neuropathic pain trial of at least 1 additional formulary agent other than such as topical capsaicin tricyclic antidepressants or least 1 additional formulary agent such as topical capsaicin tricyclic antidepressants or tried Comments I affirm that the information given on this form is true and accurate as of this date. Prior Authorization AETNA BETTER HEALTH...
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