- Prior Authorization: Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
- QL (6 per Rx);
- ST_APPLIES
- PA_APPLIES
- Diabetes Type 2: GLP1 + Combo:
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: ST_APPLIES
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