- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Prior Authorization: Cytomegalovirus (CMV):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 12
Duration: 8 week(s)
Reauthorization Required: Yes
- Cytomegalovirus (CMV):
Age Requirement: >= 12
Duration: 8 week(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: <= 8 week(s)
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