Anthem Blue Cross (HMO, PPO, EPO)
Omnipod Classic PDM (Gen 3) (insulin pump controller, RF)
Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • Step Therapy: Diabetic Medical Supplies:
    ST Multiple Brands

  • Prior Authorization: Diabetic Medical Supplies:
    Duration: 1 year(s)

  • Diabetic Medical Supplies:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • PA Applies