| Strength: | 10cm (L) |
Medication Description
Acitretin Capsule 10 MG Oral
Medication Features
| Tier | 1 |
| PA Type | No Prior Authorization |
| ST | N |
| QL | Y |
| QL Amount | 120 |
| QL Days | 30 |
| Strength: | 10cm (L) |
Acitretin Capsule 10 MG Oral
| Tier | 1 |
| PA Type | No Prior Authorization |
| ST | N |
| QL | Y |
| QL Amount | 120 |
| QL Days | 30 |