Anthem Blue Cross (HMO, PPO, EPO)
Dexcom G4 Platinum Transmitter (blood-glucose transmitter)
Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment
  • Quantity Limit: 30 day supply per 1 fill(s).
  • Prior Authorization: PA Applies
  • Available only through Specialty Pharmacy; May process through Pharmacy or Medical benefit depending on Patient location;