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Pantoprazole Sodium i.V.- Pantoprazole Sodium injection, Powder, For Solution
State of Washington (MCO)
State of Washington (MCO) Coverage for Pantoprazole Sodium i.V.- Pantoprazole Sodium injection, Powder, For Solution
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4
Commercial
2
State Medicaid
2
Commercial
Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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State Medicaid
State Medicaid - State Medicaid
PA Required
No Step Therapy
No Quantity Limit
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State Medicaid - AIDS Drug Assistance Program
No PA
No Step Therapy
Quantity Limit
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Support for Getting Your Patient on Pantoprazole Sodium i.V.- Pantoprazole Sodium injection, Powder, For Solution
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