- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 1 year(s)
- Gaucher Disease:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
- Quantity Limit: 2 devices per prescription
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