All *ANORECTAL AND RELATED PRODUCTS*

Ana-Lex Kit 2-2 % Rectal
Ana-Lex Kit 2-2 % Rectal

Lidocaine-Hydrocortisone Ace

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ana-Lex Kit 2-2 % Rectal
Ana-Lex Kit 2-2 % Rectal

Lidocaine-Hydrocortisone Ace

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Analpram HC Cream 2.5-1 % External
Analpram HC Cream 2.5-1 % External

Hydrocort-Pramoxine (Perianal)

Tier: 3
PA Type: No Prior Authorization
ST: N
Analpram HC Cream 2.5-1 % External
Analpram HC Cream 2.5-1 % External

Hydrocort-Pramoxine (Perianal)

Tier: 3
PA Type: No Prior Authorization
ST: N
Analpram HC Cream 2.5-1 % External
Analpram HC Cream 2.5-1 % External

Hydrocort-Pramoxine (Perianal)

Tier: 3
PA Type: No Prior Authorization
ST: N
Analpram HC Singles Cream 2.5-1 % External
Analpram HC Singles Cream 2.5-1 % External

Hydrocort-Pramoxine (Perianal)

Tier: 3
PA Type: No Prior Authorization
ST: N
Analpram-HC Cream 1-1 % External
Analpram-HC Cream 1-1 % External

Hydrocortisone Ace-Pramoxine

Tier: 3
PA Type: No Prior Authorization
ST: N
Analpram-HC Lotion 2.5-1 % External
Analpram-HC Lotion 2.5-1 % External

Hydrocortisone Ace-Pramoxine

Tier: 3
PA Type: No Prior Authorization
ST: N
Anucort-HC SUPPOSITORY 25 MG Rectal
Anucort-HC SUPPOSITORY 25 MG Rectal

Tier: 1
PA Type: No Prior Authorization
ST: N
Anucort-HC SUPPOSITORY 25 MG Rectal
Anucort-HC SUPPOSITORY 25 MG Rectal

Tier: 1
PA Type: No Prior Authorization
ST: N
Anucort-HC SUPPOSITORY 25 MG Rectal
Anucort-HC SUPPOSITORY 25 MG Rectal

Tier: 1
PA Type: No Prior Authorization
ST: N
Anucort-HC SUPPOSITORY 25 MG Rectal
Anucort-HC SUPPOSITORY 25 MG Rectal

Tier: 1
PA Type: No Prior Authorization
ST: N