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Xultophy
Sanford Health Plan (MCO)
Sanford Health Plan (MCO) Coverage for Xultophy
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5
Commercial
2
Health Exchange
2
Medicare
1
Commercial
Commercial - HMO
No PA
No Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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