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Cocaine Hydrochloride - Cocaine Hydrochloride solution
Premera
Premera Coverage for Cocaine Hydrochloride - Cocaine Hydrochloride solution
All
4
Commercial
3
Health Exchange
1
Commercial
Commercial - HMO
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 - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
No Quantity Limit
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