Provider
Opioid Immediate Release (IR) New To Therapy with Daily QL - Commercial
Quantity Limit
Program effective Date: May 01, 2025
Quantity Limit
Program effective Date: May 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Feb 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: May 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Sep 01, 2024
Program effective Date: Dec 22, 2021
Program effective Date: Dec 22, 2021
Program effective Date: Dec 22, 2021
Program effective Date: Dec 22, 2021
Step Therapy, Quantity Limit
Program effective Date: Jul 01, 2024