All *DIURETICS*

acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral
acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection
AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection

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