All *ANTIHISTAMINES*

Brompheniramine Maleate SOLUTION 10 MG/ML Intramuscular
Brompheniramine Maleate SOLUTION 10 MG/ML Intramuscular

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Brompheniramine Tannate Tablet Chewable 12 MG Oral
Brompheniramine Tannate Tablet Chewable 12 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Solution 4 MG/5ML Oral
Carbinoxamine Maleate Solution 4 MG/5ML Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Solution 4 MG/5ML Oral
Carbinoxamine Maleate Solution 4 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Solution 4 MG/5ML Oral
Carbinoxamine Maleate Solution 4 MG/5ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Tablet 4 MG Oral
Carbinoxamine Maleate Tablet 4 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Tablet 4 MG Oral
Carbinoxamine Maleate Tablet 4 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Tablet 4 MG Oral
Carbinoxamine Maleate Tablet 4 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Carbinoxamine Maleate Tablet 6 MG Oral
Carbinoxamine Maleate Tablet 6 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Cetirizine HCl Solution 1 MG/ML Oral
Cetirizine HCl Solution 1 MG/ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Cetirizine HCl Solution 1 MG/ML Oral
Cetirizine HCl Solution 1 MG/ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Cetirizine HCl Solution 1 MG/ML Oral
Cetirizine HCl Solution 1 MG/ML Oral

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