- Obesity:
Age Requirement: > 16
Duration: 12 week(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: <= 12 week(s)
- Step Therapy: Obesity:
ST Single Generic
- Prior Authorization: Obesity:
Documented Diagnosis: Yes
Age Requirement: > 16
Duration: 12 week(s)
Reauthorization Required: Yes
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