| UnitedHealthcare |
| Omnipod 5 G6 Pod (Gen 5) (insulin pump cart,automated,BT) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 10 pods per prescription
- Diabetes Type 1: Insulin Pumps:
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Duration Since Comprehensive Diabetes Educations Program Completed: N/A
Number of Daily Meal Time Short Acting Injections Required to Intiate Therapy: >= 3
Duration of Type 1 Pharma Therapy Required to Initiate Product: N/A
Documented Diagnosis: Yes
Diabetic Medical Supplies:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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