- Step Therapy: Diabetes Type 2: DPP4 + Combo:
ST Generic and Brand
- Prior Authorization: Diabetes Type 2: DPP4 + Combo:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
- Diabetes Type 2: DPP4 + Combo:
Age Requirement: >= 18
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
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