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Icatibant - Icatibant injection
Capital District Physicians' Health Plan (CDPHP)
Capital District Physicians' Health Plan (CDPHP) Coverage for Icatibant - Icatibant injection
All
6
Commercial
2
Health Exchange
2
Managed Medicaid
1
Medicare
1
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
See Details
Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
See Details
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Health Exchange - HDHP - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
No Quantity Limit
See Details
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