All *GENITOURINARY AGENTS - MISCELLANEOUS*

Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid SOLUTION 0.25 % IRRIGATION
Acetic Acid SOLUTION 0.25 % IRRIGATION

Tier: 1
PA Type: No Prior Authorization
ST: N
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral
Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral

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