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Xultophy
Blue Shield of California (MCO)
Blue Shield of California (MCO) Coverage for Xultophy
All
8
Commercial
3
Health Exchange
3
Medicare
2
Commercial
Commercial - PPO
PA Required
Step Therapy
Quantity Limit
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Commercial - HMO
PA Required
Step Therapy
Quantity Limit
See Details
Commercial - Employer
PA Required
Step Therapy
Quantity Limit
See Details
Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
Step Therapy
No Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
PA Required
Step Therapy
No Quantity Limit
See Details
Health Exchange - HDHP - Health Insurance Exchange
PA Required
Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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