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Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
Blue Cross and Blue Shield of South Carolina
Blue Cross and Blue Shield of South Carolina Coverage for Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
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9
Commercial
2
Health Exchange
4
Managed Medicaid
1
Medicare
2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - HDHP - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details