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Ibtrozi - Taletrectinib capsule
Blue Cross and Blue Shield of Louisiana (MCO)
Blue Cross and Blue Shield of Louisiana (MCO) Coverage for Ibtrozi - Taletrectinib capsule
All
7
Commercial
4
Health Exchange
2
Medicare
1
Commercial
Commercial - Point of Service
No PA
No Step Therapy
Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
Quantity Limit
See Details
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