| UnitedHealthcare |
| iGlucose Test Strips (blood sugar diagnostic) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Step Therapy: Diabetes Type 2: Test Strips:
ST Single Brand
- Diabetes Type 2: Test Strips:
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
Diabetic Medical Supplies:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
|