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Phentolamine Mesylate - Phentolamine Mesylate injection
Moda Health (MCO)
Moda Health (MCO) Coverage for Phentolamine Mesylate - Phentolamine Mesylate injection
All
7
Commercial
3
Health Exchange
3
Medicare
1
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - HDHP - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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