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Egrifta Wr - Tesamorelin
Blue Cross and Blue Shield of Vermont
Blue Cross and Blue Shield of Vermont Coverage for Egrifta Wr - Tesamorelin
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4
Commercial
3
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1
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Commercial - Point of Service
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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