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Step Therapy Policy for Commercial Open, Select Self-Funded Commercial Closed, Child Health Plus, Essential Plan, Small Employer Group and Direct Pay Metal Plans
Step Therapy Policy for Commercial Open, Select Self-Funded Commercial Closed, Child Health Plus, Essential Plan, Small Employer Group and Direct Pay Metal Plans
(Aczone 5%, Adapalene Lotion & Solution(RxFlex), Amitiza, Apidra, Aplenzin, Atripla, Aubagio, Betaseron, bimatoprost (For CHP Only), Bryhali, Bupropion HCL XL 450mg, Cambia, Cloderm, Clocortolone pivalate, Desonate, Dexilant, Dificid, Doryx, Doxycycline ER, Edarbi, Edarbyclor, Edluar, Emsam, Entresto, Ertaczo, Extina, Fanapt, Fiasp, Fortamet, Gelnique, Glatopa, Gleevec, Halobetasol Propionate 0.05% Foam, Halog, Hydrocortisone Butyrate 0.1% Lotion, Intermezzo, Kenalog, Khedezla, Latuda, Levalbuterol tartrate HFA, Lexette, Livalo, Lonhala Magnair, Lumigan (For CHP Only), Mentax, Metformin ER, Motegrity, Namenda XR, Nexium, Norgesic Forte, Novolog, omerprazole/sodium bicarbonate, Oracea, Oxytrol, Pandel, Pexeva, Plixda 0.1% Swab, Pradaxa, Pulmicort Flexhaler, Qbrexza, Rapaflo, Relpax, Rexulti, Rhopressa, Rozerem, Sancuso, Saphris, Savaysa, Savella, Silenor, Solutabs, Sumavel, Sympazan, Trelegy Ellipta, Trianex, Trulance, Veltassa, Venlafaxine ER, Verdeso, Vraylar, Vyzulta, Xelpros, Xolegel, Xopenex (concentrate, HFA or nebulizer solution/, Yupelri, Zegerid, Zioptan, Zolpimist, Zypitamag)

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