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Grisofulvin - Grisofulvin suspension
Passport Health Plan
Passport Health Plan Coverage for Grisofulvin - Grisofulvin suspension
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3
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1
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1
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1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
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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