All *ANTIANGINAL AGENTS*

Dilatrate-SR Capsule Extended Release 40 MG Oral
Dilatrate-SR Capsule Extended Release 40 MG Oral

Isosorbide Dinitrate ER

Tier: 3
PA Type: No Prior Authorization
ST: N
GoNitro Packet 400 MCG Sublingual
GoNitro Packet 400 MCG Sublingual

Nitroglycerin

Tier: 3
PA Type: No Prior Authorization
ST: N
GoNitro Packet 400 MCG Sublingual
GoNitro Packet 400 MCG Sublingual

Nitroglycerin

Tier: 3
PA Type: No Prior Authorization
ST: N
GoNitro Packet 400 MCG Sublingual
GoNitro Packet 400 MCG Sublingual

Nitroglycerin

Tier: 3
PA Type: No Prior Authorization
ST: N
GoNitro Packet 400 MCG Sublingual
GoNitro Packet 400 MCG Sublingual

Nitroglycerin

Tier: 3
PA Type: No Prior Authorization
ST: N
Isordil Titradose Tablet 40 MG Oral
Isordil Titradose Tablet 40 MG Oral

Isosorbide Dinitrate

Tier: 3
PA Type: No Prior Authorization
ST: N
Isordil Titradose TABLET 5 MG Oral
Isordil Titradose TABLET 5 MG Oral

Isosorbide Dinitrate

Tier: 3
PA Type: No Prior Authorization
ST: N
Isordil Titradose TABLET 5 MG Oral
Isordil Titradose TABLET 5 MG Oral

Isosorbide Dinitrate

Tier: 3
PA Type: No Prior Authorization
ST: N
Isosorbide Dinitrate ER Tablet Extended Release 40 MG Oral
Isosorbide Dinitrate ER Tablet Extended Release 40 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Isosorbide Dinitrate Tablet 10 MG Oral
Isosorbide Dinitrate Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Isosorbide Dinitrate Tablet 10 MG Oral
Isosorbide Dinitrate Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Isosorbide Dinitrate Tablet 10 MG Oral
Isosorbide Dinitrate Tablet 10 MG Oral

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