*CALCIUM CHANNEL BLOCKERS* – Exemplar Health Benefits Administrator

Adalat CC Tablet Extended Release 24 Hour 30 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 30 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 60 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 60 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 60 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 90 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Adalat CC Tablet Extended Release 24 Hour 90 MG Oral

NIFEdipine ER

Tier: 3

PA Type: No Prior Authorization

ST: N

Afeditab CR Tablet Extended Release 24 Hour 30 MG Oral

NIFEdipine ER

Tier: 1

PA Type: No Prior Authorization

ST: N

Afeditab CR Tablet Extended Release 24 Hour 30 MG Oral

NIFEdipine ER

Tier: 1

PA Type: No Prior Authorization

ST: N

Afeditab CR Tablet Extended Release 24 Hour 60 MG Oral

NIFEdipine ER

Tier: 1

PA Type: No Prior Authorization

ST: N

Afeditab CR Tablet Extended Release 24 Hour 60 MG Oral

NIFEdipine ER

Tier: 1

PA Type: No Prior Authorization

ST: N

AmLODIPine Bes+SyrSpend SF SUSPENSION 1 MG/ML Oral

AmLODIPine Besylate

Tier: Non-Formulary

PA Type: No Prior Authorization

ST: N