- Diabetes Type 2: GLP1 + Combo:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 year(s)
- Quantity Limit: limit maximum 120 EA PER 30 day(s)
- Quantity Limit: limit maximum 18 mL PER 30 day(s)
- ST Required
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