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Ormalvi - Dichlorphenamide tablet
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona Coverage for Ormalvi - Dichlorphenamide tablet
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4
Commercial
2
Health Exchange
1
Medicare
1
Commercial
Commercial - PPO
PA Required
Step Therapy
Quantity Limit
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Commercial - HMO
PA Required
Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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