UnitedHealthcare
Afrezza (insulin regular human)
Hormones : Drugs for Diabetes
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • Prior Authorization: Chronic Lymphocytic Leukemia:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

    Diffuse Large B-Cell Lymphoma, Follicular Lymphoma (FL), Mantle Cell Lymphoma, Marginal Zone Lymphoma, Multiple Myeloma, Myelodysplastic Syndrome, Non Hodgkin Lymphoma (NHL):
    Documented Diagnosis: Yes
    Duration: 1 year(s)

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