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Acetazolamide Extended - Release - Acetazolamide Extended - Release capsule
Regence BlueShield of Idaho
Regence BlueShield of Idaho Coverage for Acetazolamide Extended - Release - Acetazolamide Extended - Release capsule
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4
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2
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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 - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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