Health Net
Follistim AQ 75 Unit/0.5 Ml Soln (follitropin beta)
Hormones : Drugs for Women
  • Assisted Reproductive Technology (ART):
    Age Requirement: >= 18
    Duration: 30 Day(s)
    Gender Requirement: Female
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Reproductive Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 30 day(s)

  • Prior Authorization: Assisted Reproductive Technology (ART):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Gender Requirement: Female
    Duration: 30 Day(s)
    Reauthorization Required: Yes