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Acyclovir - Acyclovir injection, Solution
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Colorado Coverage for Acyclovir - Acyclovir injection, Solution
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5
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4
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Commercial
Commercial - HMO
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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Commercial - Other Insurer
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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