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Tacrolimus - Tacrolimus ointment
Prominence Health Plan
Prominence Health Plan Coverage for Tacrolimus - Tacrolimus ointment
All
4
Commercial
3
Medicare
1
Commercial
Commercial - HMO
No PA
Step Therapy
No Quantity Limit
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Commercial - Point of Service
No PA
Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
Quantity Limit
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