Provider
Low Molecular Weight Heparins (LMWH) and Arixtra - Commercial
Quantity Limit
Program effective Date: Jul 01, 2025
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Displaying 2121 - 2130 of 3878 results
Provider
Urinary Incontinence - Commercial
Quantity Limit
Program effective Date: Nov 01, 2024
Provider
Tezspire (tezepelumab-ekko) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: May 01, 2025
Provider
Furoscix (furosemide) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025
Provider
Antidepressant - Medicaid
Quantity Limit
Program effective Date: Jun 01, 2025
Provider
Atypical Antipsychotics - Extended Maintenance Agents - Medicaid
Quantity Limit
Program effective Date: Jul 01, 2025
Provider
Insomnia Agents - Medicaid
Quantity Limit
Program effective Date: Jul 01, 2025
Provider
Gabapentin ER (extended-release) - Medicaid
Quantity Limit
Program effective Date: Jun 01, 2025
Provider
Selective Serotonin Inverse Agonist (SSIA) - Medicaid
Quantity Limit
Program effective Date: Jul 01, 2025
Provider
Low Molecular Weight Heparins (LMWH) and Arixtra - Medicaid
Quantity Limit
Program effective Date: Jul 01, 2025