All *CARDIOVASCULAR AGENTS - MISC.*

Adempas Tablet 2 MG Oral
Adempas Tablet 2 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adempas Tablet 2 MG Oral
Adempas Tablet 2 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adempas Tablet 2 MG Oral
Adempas Tablet 2 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adempas Tablet 2.5 MG Oral
Adempas Tablet 2.5 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adempas Tablet 2.5 MG Oral
Adempas Tablet 2.5 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adempas Tablet 2.5 MG Oral
Adempas Tablet 2.5 MG Oral

Riociguat

Tier: 4
PA Type: PA Applies
PA Group: Adempas
Adenocaine Solution Prefilled Syringe Intravenous
Adenocaine Solution Prefilled Syringe Intravenous

Cardioplegic Soln

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Alyq Tablet 20 MG Oral
Alyq Tablet 20 MG Oral

Tadalafil (PAH)

Tier: 4
PA Type: PA Applies
PA Group: PAH PDE5 Inhibitors
Ambrisentan Tablet 10 MG Oral
Ambrisentan Tablet 10 MG Oral

Tier: 4
PA Type: PA Applies
PA Group: Letairis
Ambrisentan Tablet 10 MG Oral
Ambrisentan Tablet 10 MG Oral

Tier: 4
PA Type: PA Applies
PA Group: Letairis
Ambrisentan Tablet 10 MG Oral
Ambrisentan Tablet 10 MG Oral

Tier: 4
PA Type: PA Applies
PA Group: Letairis
Ambrisentan Tablet 10 MG Oral
Ambrisentan Tablet 10 MG Oral

Tier: 4
PA Type: PA Applies
PA Group: Letairis