All *DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS*

AminoPMrms Capsule Oral
AminoPMrms Capsule Oral

Nutritional Supplements

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
App Slim Rms CAPSULE ORAL
App Slim Rms CAPSULE ORAL

Nutritional Supp - Diet Aids

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AppTrim Capsule Oral
AppTrim Capsule Oral

Dietary Manage Prod - Diet Aid

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AppTrim Capsule Oral
AppTrim Capsule Oral

Dietary Manage Prod - Diet Aid

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AppTrim-D Capsule Oral
AppTrim-D Capsule Oral

Dietary Manage Prod - Diet Aid

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AppTrim-D Capsule Oral
AppTrim-D Capsule Oral

Dietary Manage Prod - Diet Aid

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AsilNasalrms Capsule Oral
AsilNasalrms Capsule Oral

Nutritional Supplements

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AstaMed MYO CAPSULE ORAL
AstaMed MYO CAPSULE ORAL

Astaxanthin-Tocotrienol-Zn-D3

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Availnex TABLET CHEWABLE 750 MG ORAL
Availnex TABLET CHEWABLE 750 MG ORAL

Carbocysteine

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Axona Packet Oral
Axona Packet Oral

Dietary Management Product

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Camino Pro 15PE Liquid Oral
Camino Pro 15PE Liquid Oral

Nutritional Supplements

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Camino Pro Complete/Glytactin BAR ORAL
Camino Pro Complete/Glytactin BAR ORAL

Nutritional Supplements

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N