All *ANTI-INFECTIVE AGENTS - MISC.*

Aemcolo Tablet Delayed Release 194 MG Oral
Aemcolo Tablet Delayed Release 194 MG Oral

Rifamycin Sodium

Tier: 3
PA Type: No Prior Authorization
ST: Y
Aemcolo Tablet Delayed Release 194 MG Oral
Aemcolo Tablet Delayed Release 194 MG Oral

Rifamycin Sodium

Tier: 3
PA Type: No Prior Authorization
ST: Y
Alinia Suspension Reconstituted 100 MG/5ML Oral
Alinia Suspension Reconstituted 100 MG/5ML Oral

Nitazoxanide

Tier: 3
PA Type: No Prior Authorization
ST: N
Alinia Suspension Reconstituted 100 MG/5ML Oral
Alinia Suspension Reconstituted 100 MG/5ML Oral

Nitazoxanide

Tier: 3
PA Type: No Prior Authorization
ST: N
Alinia Tablet 500 MG Oral
Alinia Tablet 500 MG Oral

Nitazoxanide

Tier: 3
PA Type: No Prior Authorization
ST: N
Alinia Tablet 500 MG Oral
Alinia Tablet 500 MG Oral

Nitazoxanide

Tier: 3
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Atovaquone Suspension 750 MG/5ML Oral
Atovaquone Suspension 750 MG/5ML Oral

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