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Amantadine - Amantadine capsule
Sanford Health Plan (MCO)
Sanford Health Plan (MCO) Coverage for Amantadine - Amantadine capsule
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5
Commercial
2
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2
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1
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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Health Exchange
Health Exchange - HMO - 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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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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