UnitedHealthcare
Lyumjev (insulin lispro-aabc)
Hormones : Drugs for Diabetes
  • Immune Thrombocytopenic Purpura (ITP):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Diagnosis Types: Immune Thrombocytopenic Purpura
    Baseline Platelet Count: 1 of < 30,000/mcL;Active bleed
    Required Medical Information: 2 of Medication History;Platelet count
    Supporting Documentation Must Be Submitted: Yes

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