- Step Therapy Applies
- Prior Authorization: Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
- Diabetes Type 2: GLP1 + Combo:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Supporting Documentation Requirements: 3 of Lab Tests;Medical Tests;Medication History
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