Actifoam Collagen Sponge EXTERNAL
Absorbable Collagen Hemostat
Tier: 3
PA Type: No Prior Authorization
ST: N
Actifoam Collagen Sponge EXTERNAL
Absorbable Collagen Hemostat
Tier: 3
PA Type: No Prior Authorization
ST: N
Amicar Solution 0.25 GM/ML Oral
Tier: 3
PA Type: No Prior Authorization
ST: N
Amicar Tablet 1000 MG Oral
Tier: 3
PA Type: No Prior Authorization
ST: N
Amicar Tablet 500 MG Oral
Tier: 3
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 0.25 GM/ML Oral
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 0.25 GM/ML Oral
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 0.25 GM/ML Oral
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 0.25 GM/ML Oral
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 250 MG/ML Intravenous
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 250 MG/ML Intravenous
Tier: 1
PA Type: No Prior Authorization
ST: N
Aminocaproic Acid Solution 250 MG/ML Intravenous
Tier: 1
PA Type: No Prior Authorization
ST: N