- Prior Authorization: Diabetic Medical Supplies:
Duration: 1 year(s)
- Prior Authorization: Myelofibrosis:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- Step Therapy: ST_APPLIES
- Prior Authorization: Cutaneous T-Cell Lymphomas:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
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