| Health Net |
| NovoLOG 70/30 FlexPen ReliOn (insulin asp prt-insulin aspart) |
| Hormones : Drugs for Diabetes |
- Prior Authorization: Duchenne Muscular Dystrophy (DMD):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 2
Duration: 6 Month(s)
Reauthorization Required: Yes
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