Topical Antifungals - itraconazole, terbinafine - Medicaid

Prior Authorization, Quantity Limit

Topical Antifungals - itraconazole, terbinafine - Commercial

Prior Authorization, Quantity Limit

Topiramate ER - Commercial

Prior Authorization, Quantity Limit

Proton Pump Inhibitors (PPIs) - Commercial

Step Therapy, Quantity Limit

Rayos - Commercial

Prior Authorization

Sucraid (sacrosidase) - Medicaid

Prior Authorization, Quantity Limit

Sucraid (sacrosidase) - Commercial

Prior Authorization, Quantity Limit

Proton Pump Inhibitors (PPIs) - Medicaid

Quantity Limit

Sohonos - Commercial

Prior Authorization, Quantity Limit

QP113-25 Use of the TS Modifier