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PacificSource Health Plans
PacificSource Health Plans Coverage for Vivitrol
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6
Commercial
3
Health Exchange
2
Medicare
1
Commercial
Commercial - PPO
No PA
No Step Therapy
Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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