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Dalfampridine - Dalfampridine tablet, Extended Release
Blue Shield of California (MCO)
Blue Shield of California (MCO) Coverage for Dalfampridine - Dalfampridine tablet, Extended Release
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8
Commercial
3
Health Exchange
3
Medicare
2
Commercial
Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Health Exchange - HDHP - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
Quantity Limit
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Medicare - Prescription Drug Plan
PA Required
No Step Therapy
Quantity Limit
See Details
Support for Getting Your Patient on Dalfampridine - Dalfampridine tablet, Extended Release
Check medication interactions
Screen for drug-drug and drug-condition conflicts.