- Quantity Limit: 30 day supply per 1 fill(s).
- Quantity Limit: limit maximum 6 EA PER 28 day(s)
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- QL applies to members age 65 and older;
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