All *GASTROINTESTINAL AGENTS - MISC.*

Actigall Capsule 300 MG Oral
Actigall Capsule 300 MG Oral

Ursodiol

Tier: 3
PA Type: No Prior Authorization
ST: N
Actigall Capsule 300 MG Oral
Actigall Capsule 300 MG Oral

Ursodiol

Tier: 3
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 0.5 MG Oral
Alosetron HCl Tablet 0.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 1 MG Oral
Alosetron HCl Tablet 1 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 1 MG Oral
Alosetron HCl Tablet 1 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 1 MG Oral
Alosetron HCl Tablet 1 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alosetron HCl Tablet 1 MG Oral
Alosetron HCl Tablet 1 MG Oral

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