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Xultophy
Blue Cross and Blue Shield of South Carolina
Blue Cross and Blue Shield of South Carolina Coverage for Xultophy
All
9
Commercial
2
Health Exchange
4
Managed Medicaid
1
Medicare
2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
See Details
Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
See Details
Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
See Details
Health Exchange - HDHP - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
See Details
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
Quantity Limit
See Details
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
No Quantity Limit
See Details
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