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CIGNA PRESCRIPTION DRUG LIST
Compare medication prices using the Prescription ... the Prescription Drug Price Quote tool on myCigna.com to find out if this medication is ..... Benzefoam.
formulary-prescriptions.pdf

2017 Drugs Requiring Prior Authorization List - CareSource
Jan 4, 2017 ... Lower Cost. Requires .... ACITRETIN (SORIATANE) 10 mg CAPSULE Lower Cost. Formulary ...... (BENZEFOAM) 5.3% EMOLLIENT FOAM.
oh-medicaid-drugs-that-require-prior-authorization

Pharmacy Benefit Programs Drug List - UnitedHealthcareOnline.com
Jun 8, 2017 ... BenzEfoam / BenzEfoam Ultra. Skin Conditions - Acne x. Bepreve. Ophthalmic Agents x x. Berinert. Hereditary Angioedema x x x. Besivance.
Clinical_Programs.pdf

Molina Healthcare of Ohio Prior Authorization (PA) List
Lower Cost Alternatives = There is another drug that does the same as the Prior .... BENZEFOAM ULTRA 9.8% FOAM LOWER COST ALTERNATIVES.
RxInfo_OH_providerpharmacypriorauthorizationlist.pdf

Alternative Drug List - MyPrime
Jan 1, 2017 ... most cases, if you fill a prescription for any of the drugs listed under the Excluded Medications column, you will pay the full retail price. This list ...
AL_Drug_Exclusion_List.pdf

1199SEIU Funds Preferred Drug List (PDL)
BenzEFoam®/BenzEFoam® Ultra benzoyl peroxide (generic). Bepreve® azelastine (generic), cromolyn (generic), epinastine (generic), olopatadine ( generic) ...
1199SEIU-Funds-Preferred-Drug-List.pdf

cigna legacy performance prescription drug list - Federated Insurance
Here's more helpful information on how to read this drug list: Tiers. Covered medications are divided into tiers, or coverage/cost levels. The tier the medication is ...
idcplg?IdcService=GET_FILE&dDocName=PROD_177107&RevisionSelectionMethod=Latest

Drug Coverage Guidelines - Oxford Health Plans
6 days ago ... ... definitions below, copayment/cost share will vary based on the Member's plan design. ..... Prevention Zero Cost Share* .... BenzeFoam Ultra.
drug_coverage_guidelines.pdf

Prescription Drug List In Alphabetical Order - Caremark
Dec 22, 2014 ... effective, and cost effective alternatives available. Our goal ... are covered, based on clinical practice guidelines and cost- ..... BenzEFoam Ultra.
TuftsByDrug_0.pdf

Prime Perspective - Prime Therapeutics
Mar 1, 2016 ... the preferred drug price. What you need to do .... Benzefoam BPO, Clarifoam EF, Cleocin-T, Clindacin. PAC, Clindagel, Duac, Epiduo, Evoclin, ...
3833_PrimePerspective_1Q2016_FINAL.pdf.pdf

preferred drug list - Department of Vermont Health Access
Jan 15, 2013 ... cost control program designed to reduce the cost of providing prescription ...... Benzoyl Peroxide Aerosol (Foam) and Benzefoam® not covered.
2013-01-vt-clinical-criteria-january-15-2013-final.pdf

Preferred Drug List (PDL) - Department of Vermont Health Access
Jan 1, 2015 ... reduce the cost of providing prescription drugs, while maintaining ... Benzoyl Peroxide Aerosol(foam) Benzefoam and Riax Foam not covered.
vermont-pdl-20150101.pdf

PHP HIX ESSENTIAL FORMULARY MEMBER GUIDE_v4.indd
For the most up-to-date information on coverage and cost of a medication you can call the PHP Customer Service. Department at 1 ...... BENZEFOAM ULTRA.
Commercial Member Prescription Drug List (PDL).PDF

Georgia Medicaid/PeachCare Preferred Drug List - Georgia.gov
Jan 1, 2014 ... BENZEFOAM. NP. PA. QLL benzoyl peroxide cleanser generic. P benzoyl peroxide cream 5.5% generic. NP. PA. QLL benzoyl peroxide pads ...
PDL by Drug Name - Effective 1.1.14.pdf

Drug Prior Authorization List - Paramount Health Care
AMITIZA. ARCALYST. AZASITE EYE DROPS. Drugs requiring a PA for clinical or cost reasons ... BENZEFOAM. CLONAZEPAM ODT. DOXYCYCLINE MONO 75 ...
drug-prior-authorization-list-advantage.pdf

Preferred Drug List - Pehp
cost. The Preferred Drug. List is modified periodically with changes based on recommendations from ...... Benzefoam. Beyaz. Bifera. Bravelle. Brintellix ( Trintellix).
preferreddruglist_1014_sw_FEA07B92.pdf

2015 empire plan flexible formulary drug list - CSEA Local 870
Jan 1, 2015 ... You will be responsible for the full cost of non-formulary products ... the generic, not to exceed the full retail cost of the drug ...... BENZEFOAM.
Empire-Plan-Flexible-Formulary-2015.pdf

BAP Background Information - Health.mil
Sep 22, 2016 ... most cost-effective agents, followed by branded formulations of clindamycin/ .... kit (Benzac, Benzac Wash, BenzEFoam, BenzEFoam Ultra,.
Background-Information-22-Sept-2016

2016 Prescription drug formulary - Novant Health UVA Health System
Jan 1, 2016 ... Olux-e betamethasone valerate. Benzamycin. Pandel calcipotriene/ betamethasone dipropionate. Benzefoam. Pediaderm HC. Benzefoamultra.
2016 Pharmacy plan formulary.pdf

Prescription Drug Formulary - cloudfront.net
Oct 1, 2016 ... 3 tretinoin. Benzefoam /Benzefoam Ultra. 3 benzoyl peroxide. BPS gel. 3 benzoyl peroxide. Benzoyl Peroxide 2.5% wash. 3 benzoyl peroxide.
RxFormulary.pdf