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Gocovri - Amantadine capsule, Coated Pellets
Denver Health Medical Plan (MCO)
Denver Health Medical Plan (MCO) Coverage for Gocovri - Amantadine capsule, Coated Pellets
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4
Health Exchange
2
Managed Medicaid
1
Medicare
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
Step Therapy
No Quantity Limit
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Health Exchange - HDHP - Health Insurance Exchange
PA Required
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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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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