Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting

Assigned Number	Title	Version Date	Publication Type	Other Location	Language
F-01749	Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting	July 1, 2021	Word	None	English
F-01749	Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting	July 1, 2021	PDF	None	English
F-01749	Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting, Instructions	July 1, 2021	PDF	None	English

Last Revised: July 1, 2021