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Gocovri - Amantadine capsule, Coated Pellets
Blue Cross and Blue Shield of Louisiana (MCO)
Blue Cross and Blue Shield of Louisiana (MCO) Coverage for Gocovri - Amantadine capsule, Coated Pellets
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7
Commercial
4
Health Exchange
2
Medicare
1
Commercial
Commercial - Point of Service
PA Required
Step Therapy
Quantity Limit
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Commercial - PPO
PA Required
Step Therapy
Quantity Limit
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Commercial - HMO
PA Required
Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No 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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