- Sickle Cell Disease:
Age Requirement: >= 5
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Quantity Limit: limit maximum 900 ML PER 30 day(s)
- Quantity Limit: 200 syringes per 30 day(s).
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