Limited coverage - additional blood glucose test strips
Last updated: October 24, 2022
Special Authority criteria |
Approval period |
Patient has diabetes, is not on insulin OR Patient has diabetes, is on insulin and is using a continuous glucose monitor (CGM), and is experiencing at least one of the following:
OR
OR
OR
OR
|
Not applicable |
Practitioner exemptions
- None
Special notes
Special Authority request form(s)