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Xifaxan
Premera
Premera Coverage for Xifaxan
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4
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3
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1
Commercial
Commercial - PPO
PA Required
Step Therapy
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Commercial - Employer
PA Required
Step Therapy
Quantity Limit
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Commercial - HMO
PA Required
Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
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