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Gatifloxacin Ophthalmic Solution 0.5%
Group Health Cooperative of South Central Wisconsin (MCO)
Group Health Cooperative of South Central Wisconsin (MCO) Coverage for Gatifloxacin Ophthalmic Solution 0.5%
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6
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4
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1
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1
Commercial
Commercial - HMO
No PA
Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
Step Therapy
No Quantity Limit
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Commercial - Point of Service
No PA
Step Therapy
No Quantity Limit
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Commercial - Other Insurer
No PA
Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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