- Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- QL (720 per 365 days; 120 per dispense);
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- Quantity Limit: 34g (2 bottles) per month
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