All *ALLERGENIC EXTRACTS/BIOLOGICALS MISC*

Acacia SOLUTION 1:20 Subcutaneous
Acacia SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Acremonium SOLUTION 20000 PNU/ML Subcutaneous
Acremonium SOLUTION 20000 PNU/ML Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Alder SOLUTION 1:20 Subcutaneous
Alder SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Alternaria Solution 20000 PNU/ML Subcutaneous
Alternaria Solution 20000 PNU/ML Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Alternaria Solution 20000 PNU/ML Subcutaneous
Alternaria Solution 20000 PNU/ML Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Beech SOLUTION 1:20 Subcutaneous
American Beech SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Cockroach SOLUTION 1:20 Subcutaneous
American Cockroach SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Cockroach SOLUTION 1:20 Subcutaneous
American Cockroach SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Elm Solution 1:20 Subcutaneous
American Elm Solution 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Elm Solution 1:20 Subcutaneous
American Elm Solution 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
American Sycamore Solution 1:20 Subcutaneous
American Sycamore Solution 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Arizona Cypress SOLUTION 1:20 Subcutaneous
Arizona Cypress SOLUTION 1:20 Subcutaneous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N