| HealthNet - All plan years |
| MetroLotion (metronidazole) |
| Drugs for the Skin : Drugs for the Skin |
- ST_APPLIES
- Diabetes Type 2: GLP1 + Combo:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Supporting Documentation Requirements: Medication History
|