Anthem Blue Cross (HMO, PPO, EPO) |
Omnipod DASH PDM (Gen 4) (insulin pump controller) |
Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Step Therapy: Diabetic Medical Supplies:
ST Multiple Brands
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Diabetic Medical Supplies:
Duration: 1 year(s)
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