Sign In
Coverage
Check coverage
Home
Acyclovir Sodium - Acyclovir Sodium injection, Solution
Upper Peninsula Health Plan (MCO)
Upper Peninsula Health Plan (MCO) Coverage for Acyclovir Sodium - Acyclovir Sodium injection, Solution
All
2
Managed Medicaid
1
Medicare
1
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
No Quantity Limit
See Details
Support for Getting Your Patient on Acyclovir Sodium - Acyclovir Sodium injection, Solution
Check medication interactions
Does Upper Peninsula Health Plan Cover Acyclovir Sodium? 2 Plans (2026)