| Anthem Blue Cross (HMO, PPO, EPO) |
| Easy Trak II Glucose Test (blood sugar diagnostic) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Diabetic Medical Supplies:
ST Multiple Brands
- Prior Authorization: Diabetic Medical Supplies:
Duration: 1 year(s)
- Quantity Limit: 204 strips per 30 day(s).
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