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;
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