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Trijardy XR
Wellpoint
Wellpoint Coverage for Trijardy XR
All
4
Health Exchange
3
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
Quantity Limit
See Details
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