| Anthem Blue Cross (HMO, PPO, EPO) |
| POGO Automatic Test Cartridges (lancets-blood glucose strips) |
| Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment |
- Prior Authorization: Diabetes Type 2: Test Strips:
Documented Diagnosis: Yes
Duration: 1 year(s)
Diabetic Medical Supplies:
Duration: 1 year(s)
- Step Therapy: ST Multiple Brands
- Diabetes Type 2: Test Strips:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
Diabetic Medical Supplies:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 200 tests per 30 day(s).
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