All *ENDOCRINE AND METABOLIC AGENTS - MISC.*

Acthar Gel 80 UNIT/ML Injection
Acthar Gel 80 UNIT/ML Injection

Corticotropin

Tier: 4
PA Type: PA Applies
PA Group: Acthar HP
Actonel TABLET 150 MG ORAL
Actonel TABLET 150 MG ORAL

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Actonel TABLET 150 MG ORAL
Actonel TABLET 150 MG ORAL

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Actonel Tablet 30 MG Oral
Actonel Tablet 30 MG Oral

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Actonel Tablet 35 MG Oral
Actonel Tablet 35 MG Oral

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Actonel Tablet 35 MG Oral
Actonel Tablet 35 MG Oral

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Actonel Tablet 5 MG Oral
Actonel Tablet 5 MG Oral

Risedronate Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Aldurazyme SOLUTION 2.9 MG/5ML Intravenous
Aldurazyme SOLUTION 2.9 MG/5ML Intravenous

Laronidase

Tier: Non-Formulary
PA Type: PA Applies
PA Group: Aldurazyme
Alendronate Sodium Solution 70 MG/75ML Oral
Alendronate Sodium Solution 70 MG/75ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alendronate Sodium Solution 70 MG/75ML Oral
Alendronate Sodium Solution 70 MG/75ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alendronate Sodium Tablet 10 MG Oral
Alendronate Sodium Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alendronate Sodium Tablet 10 MG Oral
Alendronate Sodium Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N