- Prior Authorization: Idiopathic Pulmonary Fibrosis (IPF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- May be covered under Medical Benefit.
- Step Therapy: Neurology: Epilepsy:
ST Single Brand
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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