Prior Authorization

Would you like to refer a patient that needs a prior authorization for a Continuous Glucose Monitor or an Insulin Pump?

If so, please fax the following to (833) 329-6979/(833) FAX-MY RX

  1. Standard Written Order/Prescription for CGM reader and Sensor or Insulin Pump and supplies
  2. Medical records/chart notes.
  1. Patient Demographics
  2. Copy of patient’s insurance card.