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Xifaxan
Providence Health Plan
Providence Health Plan Coverage for Xifaxan
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6
Commercial
3
Health Exchange
1
Managed Medicaid
1
Medicare
1
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
Quantity Limit
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Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
Step Therapy
Quantity Limit
See Details
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