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Ampicillin - Ampicillin capsule
Blue Cross and Blue Shield of Illinois
Blue Cross and Blue Shield of Illinois Coverage for Ampicillin - Ampicillin capsule
All
7
Commercial
3
Health Exchange
3
Managed Medicaid
1
Commercial
Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
See Details
Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
See Details
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