All *ANTIARRHYTHMICS*

Adenocard Solution 12 MG/4ML Intravenous
Adenocard Solution 12 MG/4ML Intravenous

Adenosine

Tier: 3
PA Type: No Prior Authorization
ST: N
Adenocard Solution 6 MG/2ML Intravenous
Adenocard Solution 6 MG/2ML Intravenous

Adenosine

Tier: 3
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 12 MG/4ML Intravenous
Adenosine Solution 12 MG/4ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 6 MG/2ML Intravenous
Adenosine Solution 6 MG/2ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 6 MG/2ML Intravenous
Adenosine Solution 6 MG/2ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Adenosine Solution 6 MG/2ML Intravenous
Adenosine Solution 6 MG/2ML Intravenous

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