| Cigna + Oscar |
| Ozempic (0.25 or 0.5 MG/DOSE) (semaglutide) |
| Hormones : Drugs for Diabetes |
- PA Applies
- Step Therapy: Derm: Acne Vulgaris:
ST Single Generic
- Diabetic Medical Supplies:
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
|