All *ANTIPARKINSON AND RELATED THERAPY AGENTS*

Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amantadine HCl Capsule 100 MG Oral
Amantadine HCl Capsule 100 MG Oral

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