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Lidocaine Hydrochloride - Lidocaine Hydrochloride solution
Passport Health Plan
Passport Health Plan Coverage for Lidocaine Hydrochloride - Lidocaine Hydrochloride solution
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3
Health Exchange
1
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1
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1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
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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