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Ampicillin - Ampicillin capsule
Horizon Blue Cross and Blue Shield of New Jersey
Horizon Blue Cross and Blue Shield of New Jersey Coverage for Ampicillin - Ampicillin capsule
All
7
Commercial
4
Health Exchange
1
Medicare
2
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
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Commercial - Point of Service
No PA
No Step Therapy
No Quantity Limit
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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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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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