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Xultophy
Aetna Health
Aetna Health Coverage for Xultophy
All
8
Commercial
5
Managed Medicaid
1
Medicare
2
Commercial
Commercial - Other Insurer
No PA
Step Therapy
No Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Point of Service
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
No Quantity Limit
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Medicare
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
Quantity Limit
See Details
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