| Anthem Blue Cross (HMO, PPO, EPO) |
| Prodigy Autocode Meter (Misc) (blood-glucose meter) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Diabetic Medical Supplies:
Duration: 1 year(s)
- Step Therapy: Diabetic Medical Supplies:
ST Single Brand
|