All *ANTIFUNGALS*

Abelcet SUSPENSION 5 MG/ML Intravenous
Abelcet SUSPENSION 5 MG/ML Intravenous

Amphotericin B Lipid

Tier: 3
PA Type: No Prior Authorization
ST: N
AmBisome SUSPENSION RECONSTITUTED 50 MG Intravenous
AmBisome SUSPENSION RECONSTITUTED 50 MG Intravenous

Amphotericin B Liposome

Tier: 3
PA Type: No Prior Authorization
ST: N
Amphotericin B Solution Reconstituted 50 MG Intravenous
Amphotericin B Solution Reconstituted 50 MG Intravenous

Tier: 3
PA Type: No Prior Authorization
ST: N
Ancobon Capsule 250 MG Oral
Ancobon Capsule 250 MG Oral

Flucytosine

Tier: 3
PA Type: No Prior Authorization
ST: N
Ancobon Capsule 500 MG Oral
Ancobon Capsule 500 MG Oral

Flucytosine

Tier: 3
PA Type: No Prior Authorization
ST: N
Bio-Statin CAPSULE 1000000 UNIT ORAL
Bio-Statin CAPSULE 1000000 UNIT ORAL

Tier: 3
PA Type: No Prior Authorization
ST: N
Bio-Statin CAPSULE 500000 UNIT ORAL
Bio-Statin CAPSULE 500000 UNIT ORAL

Tier: 3
PA Type: No Prior Authorization
ST: N
Bio-Statin CAPSULE 500000 UNIT ORAL
Bio-Statin CAPSULE 500000 UNIT ORAL

Tier: 3
PA Type: No Prior Authorization
ST: N
Bio-Statin POWDER ORAL
Bio-Statin POWDER ORAL

Tier: 1
PA Type: No Prior Authorization
ST: N
Bio-Statin POWDER ORAL
Bio-Statin POWDER ORAL

Tier: 1
PA Type: No Prior Authorization
ST: N
Bio-Statin POWDER ORAL
Bio-Statin POWDER ORAL

Tier: 1
PA Type: No Prior Authorization
ST: N
Bio-Statin POWDER ORAL
Bio-Statin POWDER ORAL

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