Health Net
Egrifta SV (tesamorelin)
Hormones : Drugs for Growth
  • Prior Authorization: HIV Lipodystrophy:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • HIV Lipodystrophy:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)