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Amantadine Hydrochloride - Amantadine Hydrochloride tablet
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Montana Coverage for Amantadine Hydrochloride - Amantadine Hydrochloride tablet
All
4
Commercial
2
Health Exchange
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
See Details
Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
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