| Health Net |
| Dexcom G6 Receiver (blood-glucose meter,continuous) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Diabetic Medical Supplies:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Step Therapy: Diabetic Medical Supplies:
ST Single Brand
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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