| Health Net |
| Lumizyme (alglucosidase alfa) |
| Drugs for Metabolic Disease : Drugs for Metabolic Disease |
- Prior Authorization: Pompe Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Pompe Disease:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: >= 6 month(s)
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