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Acetaminophen And Codeine Phosphate - Acetaminophen And Codeine Phosphate tablet
BlueCross BlueShield of Tennessee
BlueCross BlueShield of Tennessee Coverage for Acetaminophen And Codeine Phosphate - Acetaminophen And Codeine Phosphate tablet
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5
Commercial
2
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1
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1
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1
Commercial
Commercial - PPO
PA Required
No Step Therapy
No Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
Quantity Limit
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