- Prior Authorization: HIV Wasting:
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- HIV Wasting:
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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