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Acyclovir - Acyclovir injection, Solution
University of Utah Health Plans (MCO)
University of Utah Health Plans (MCO) Coverage for Acyclovir - Acyclovir injection, Solution
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5
Commercial
3
Health Exchange
1
Managed Medicaid
1
Commercial
Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
No Quantity Limit
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Support for Getting Your Patient on Acyclovir - Acyclovir injection, Solution
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