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Dicyclomine Hydrochloride - Dicyclomine Hydrochloride tablet
Highmark Blue Shield of Northeastern New York
Highmark Blue Shield of Northeastern New York Coverage for Dicyclomine Hydrochloride - Dicyclomine Hydrochloride tablet
All
6
Commercial
4
Health Exchange
1
Medicare
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 - Point of Service
No PA
No Step Therapy
No Quantity Limit
See Details
Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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