Provider
QP74-23 Commercial Pharmacy Benefit Exclusion for Abilify Asimtufii®, Adstiladrin®, Brixadi™, Glydo®, lidocaine 2%, Roctavian™, and Uzedy™
Program effective Date: Sep 13, 2023
Program effective Date: Sep 13, 2023
Program effective Date: Sep 13, 2023
Program effective Date: Sep 13, 2023
Quantity Limit
Program effective Date: Oct 01, 2024
Program effective Date: Sep 01, 2023
Program effective Date: Sep 01, 2023
Program effective Date: Sep 01, 2023
Program effective Date: Sep 01, 2023
Program effective Date: Sep 27, 2023