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Dalvance
Independence Blue Cross (MCO)
Independence Blue Cross (MCO) Coverage for Dalvance
All
8
Commercial
3
Health Exchange
2
Managed Medicaid
1
Medicare
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
Commercial - Point of Service
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
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Health Exchange - HMO - 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
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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