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Xalatan
Blue Shield of California (MCO)
Blue Shield of California (MCO) Coverage for Xalatan
All
8
Commercial
3
Health Exchange
3
Medicare
2
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 - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - HDHP - 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
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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