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Levorphanol Tartrate - Levorphanol Tartrate tablet
Highmark Blue Cross Blue Shield West Virginia
Highmark Blue Cross Blue Shield West Virginia Coverage for Levorphanol Tartrate - Levorphanol Tartrate tablet
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2
Commercial
1
Managed Medicaid
1
Commercial
Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
Quantity Limit
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