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Get Cigna Viscosupplementation Prior Authorization Form

Medical (MED) Benefit MED Type of Review Care Management Type of Review Precertification Fax: 617-972-9409 Department to Review Pre-Cert Note: This pharmacy medical necessity guideline applies to commercial products. For Tufts Health Plan Medicare Preferred members, please refer to the Tufts Health Plan Medicare Preferred Prior Authorization Criteria. Background, applicable product and disclaimer information can be found on the last page. OVERVIEW Osteoarthritis (OA) is the most.

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