All *ANTIANXIETY AGENTS*

ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral
ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam Intensol Concentrate 1 MG/ML Oral
ALPRAZolam Intensol Concentrate 1 MG/ML Oral

ALPRAZolam

Tier: 3
PA Type: No Prior Authorization
ST: N
ALPRAZolam Tablet 0.25 MG Oral
ALPRAZolam Tablet 0.25 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam Tablet 0.25 MG Oral
ALPRAZolam Tablet 0.25 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
ALPRAZolam Tablet 0.25 MG Oral
ALPRAZolam Tablet 0.25 MG Oral

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