- Diabetic Medical Supplies:
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Quantity Limit: 30 day supply per 1 fill(s).
- Quantity Limit: limit maximum 7 EA PER 30 day(s)
- Step Therapy: ST_APPLIES
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