All *MISCELLANEOUS THERAPEUTIC CLASSES*

Zokinvy Capsule 75 MG Oral
Zokinvy Capsule 75 MG Oral

Lonafarnib

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Zortress Tablet 0.25 MG Oral
Zortress Tablet 0.25 MG Oral

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N
Zortress Tablet 0.25 MG Oral
Zortress Tablet 0.25 MG Oral

Everolimus

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

Everolimus

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

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N
Zortress Tablet 0.75 MG Oral
Zortress Tablet 0.75 MG Oral

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N
Zortress Tablet 0.75 MG Oral
Zortress Tablet 0.75 MG Oral

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N
Zortress Tablet 1 MG Oral
Zortress Tablet 1 MG Oral

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N
Zortress Tablet 1 MG Oral
Zortress Tablet 1 MG Oral

Everolimus

Tier: 3
PA Type: No Prior Authorization
ST: N