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Hyftor - Sirolimus gel
Kaiser Foundation Health Plan of Washington
Kaiser Foundation Health Plan of Washington Coverage for Hyftor - Sirolimus gel
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5
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4
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1
Commercial
Commercial - HMO
PA Required
No Step Therapy
No Quantity Limit
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Commercial - PPO
PA Required
No Step Therapy
No Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
Quantity Limit
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Commercial - Other Insurer
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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