- Prior Authorization: Obesity:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 4 Month(s)
Reauthorization Required: Yes
- Obesity:
Age Requirement: >= 18
Duration: 4 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- Step Therapy: Obesity:
ST Single Brand
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