File name: Navitus Formulary 2024 Pdf
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Introduction: This booklet provides a list of Navitus MedicareRx’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, . • This plan, Navitus MedicareRx, offered by Dean Health Insurance, Inc., is a Prescription Drug Plan (PDP) with a Medicare contract. Enrollment depends on contract renewal. Last Updated 1/1/ University of Kansas Health System Formulary abacavir soln (ZIAGEN equiv) - 1 ANTIVIRALS abacavir tab (ZIAGEN equiv) - 1 ANTIVIRALS abacavir/lamivudine tab . Navitus Medicare Formulary Last Updated Step Therapy Criteria 11/1/ Products Affected AUVELITY MG ER TAB Details Step Therapy requires trial of one of the following generic SSRI 's: escitalopram, sertraline, fluoxetine, citalopram, paroxetine or fluvoxamine. Criteria 1. Last Updated 1/1/ University of Kansas Health System Formulary Cont. acitretin cap (SORIATANE equiv) - 1 DERMATOLOGICALS ACTEMRA ACTPEN INJ (QL= 2 inj/28 days) PA-QL-MSP 2 ANALGESICS - ANTI-INFLAMMATORY ACTEMRA SC INJ (QL= 2 inj/28 days) PA-QL-MSP 2 ANALGESICS - ANTI-INFLAMMATORY ENDOCRINE AND METABOLIC AGENTS - MISC. This plan, Navitus MedicareRx, offered by Dean Health Insurance, Inc., is a Prescription Drug Plan (PDP) with a Medicare contract. Enrollment depends on contract renewal.