All *ANTICONVULSANTS*

Briviact TABLET 100 MG ORAL
Briviact TABLET 100 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
Briviact TABLET 25 MG ORAL
Briviact TABLET 25 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
Briviact TABLET 25 MG ORAL
Briviact TABLET 25 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
Briviact TABLET 50 MG ORAL
Briviact TABLET 50 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
Briviact TABLET 50 MG ORAL
Briviact TABLET 50 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
Briviact TABLET 75 MG ORAL
Briviact TABLET 75 MG ORAL

Brivaracetam

Tier: 3
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral
CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral

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