| Health Net |
| V-Go 20 (sub-q insulin device, 20 unit) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Diabetic Medical Supplies:
Age Requirement: >= 21
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Endocrinologist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Age Requirement: >= 21
Duration: 6 Month(s)
Reauthorization Required: Yes
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