- Cytomegalovirus (CMV):
Age Requirement: >= 12
Duration: 8 week(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Prior Authorization: Cytomegalovirus (CMV):
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 8 week(s)
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