| Sharp Health Plan - All plan years |
| Qtern (dapagliflozin-saxagliptin) |
| Hormones : Drugs for Diabetes |
- Quantity Limit: limit maximum 2 ML PER 30 day(s)
- 1;
- Prior Authorization: Chemo-induced Nausea and Vomiting (CINV):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Day(s)
Reauthorization Required: Yes
HIV Wasting:
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
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