Provider
QP83-23 Commercial Pharmacy Benefit Exclusion for Budesonide-Formoterol Aerosol Inhaler and Tiotropium Bromide Inhalation Capsule
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023
Quantity Limit
Program effective Date: Nov 01, 2024
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: May 01, 2025
Program effective Date: Oct 11, 2023
Program effective Date: Oct 11, 2023