| Anthem Blue Cross (HMO, PPO, EPO) |
| Januvia (sitagliptin) |
| Hormones : Drugs for Diabetes |
- ST_APPLIES
- Diabetic Medical Supplies:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: limit maximum 2 GM PER 1 day(s)
- Quantity Limit: QL (28 ampules/ 28 days
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