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Xeljanz
Passport Health Plan
Passport Health Plan Coverage for Xeljanz
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3
Health Exchange
1
Managed Medicaid
1
Medicare
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
Step Therapy
Quantity Limit
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