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Lupron Depot
OptumRx (MCO)
OptumRx (MCO) Coverage for Lupron Depot
All
3
Commercial
2
Medicare
1
Commercial
Commercial - Employer
PA Required
Step Therapy
No Quantity Limit
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Commercial - PBM Offering
PA Required
Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Prescription Drug Plan
PA Required
Step Therapy
Quantity Limit
See Details
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