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Lupron Depot
Fidelis Care New York (MCO)
Fidelis Care New York (MCO) Coverage for Lupron Depot
All
3
Health Exchange
1
Managed Medicaid
1
Medicare
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
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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