Health Net
Dexcom G4 Platinum Receiver (blood-glucose meter,continuous)
Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment
  • Available only through Specialty Pharmacy; Limited access;
  • Substance Abuse: Opioid Dependence:
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Negative Test for Opioids: No
    Required Time Duration Abstaining from Opioids: N/A
    Rehabilitation Program Required: No
    Policy Specifies Induction or Initiation of Therapy: No
    Documented Diagnosis: Yes
    Induction Period Specified: No

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