- Prior Authorization: Cytomegalovirus (CMV):
Documented Diagnosis: Yes
Duration: 2 Month(s)
- Cytomegalovirus (CMV):
Duration: 2 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
- Quantity Limit: (4 tablets per day)
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