All *GOUT AGENTS*

Allopurinol Sodium Solution Reconstituted 500 MG Intravenous
Allopurinol Sodium Solution Reconstituted 500 MG Intravenous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Allopurinol Tablet 100 MG Oral
Allopurinol Tablet 100 MG Oral

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