- Quantity Limit: 0.05 units per 1 day(s).
- Prior Authorization: PA_APPLIES
- Quantity Limit: limit maximum 14 EA PER 23 day(s)
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Available through Specialty Pharmacy;
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