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Xiidra
Medical Mutual of Ohio
Medical Mutual of Ohio Coverage for Xiidra
All
7
Commercial
5
Health Exchange
1
Medicare
1
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - PPO
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 - Point of Service
PA Required
No Step Therapy
Quantity Limit
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Commercial - Other Insurer
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
Quantity Limit
See Details
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