All *CORTICOSTEROIDS*

Active Injection BLM-1 KIT 6 & 0.25 & 1 MG/ML-%-% INJECTION
Active Injection BLM-1 KIT 6 & 0.25 & 1 MG/ML-%-% INJECTION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection BM KIT 6 & 0.25 MG/ML-% INJECTION
Active Injection BM KIT 6 & 0.25 MG/ML-% INJECTION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection D KIT 10 MG/ML Injection
Active Injection D KIT 10 MG/ML Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection DL KIT 10 & 1 MG/ML-% INJECTION
Active Injection DL KIT 10 & 1 MG/ML-% INJECTION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection DLM KIT 10 & 0.25 & 1 MG/ML-%-% INJECTION
Active Injection DLM KIT 10 & 0.25 & 1 MG/ML-%-% INJECTION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection Kit L KIT 40 & 1 MG/ML-% Injection
Active Injection Kit L KIT 40 & 1 MG/ML-% Injection

Methylprednisolone Ace-Lido

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection KL-3 KIT 40-1 MG/ML-% COMBINATION
Active Injection KL-3 KIT 40-1 MG/ML-% COMBINATION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection KM Kit 40-0.5 MG/ML-% Injection
Active Injection KM Kit 40-0.5 MG/ML-% Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection LM-DEP-1 Kit 80 & 0.25 & 1 MG/ML-%-% Injection
Active Injection LM-DEP-1 Kit 80 & 0.25 & 1 MG/ML-%-% Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection LM-DEP-2 Kit 40 & 0.25 & 1 MG/ML-%-% Injection
Active Injection LM-DEP-2 Kit 40 & 0.25 & 1 MG/ML-%-% Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Active Injection M-1 KIT 10 & 0.25 MG/ML-% INJECTION
Active Injection M-1 KIT 10 & 0.25 MG/ML-% INJECTION

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Alkindi Sprinkle Capsule Sprinkle 0.5 MG Oral
Alkindi Sprinkle Capsule Sprinkle 0.5 MG Oral

Hydrocortisone

Tier: 3
PA Type: PA Applies
PA Group: Alkindi