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Xultophy
FEPBlue
FEPBlue Coverage for Xultophy
All
3
Commercial
2
Medicare
1
Commercial
Commercial - Other Insurer
PA Required
Step Therapy
No Quantity Limit
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Commercial - Employer
PA Required
Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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