All *MOUTH/THROAT/DENTAL AGENTS*

Aquoral Solution Mouth/Throat
Aquoral Solution Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Aquoral Solution Mouth/Throat
Aquoral Solution Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Arestin 1 MG DENTAL
Arestin 1 MG DENTAL

Minocycline HCl

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
BocaSal Packet Mouth/Throat
BocaSal Packet Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
BocaSal Packet Mouth/Throat
BocaSal Packet Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
BocaSal Packet Mouth/Throat
BocaSal Packet Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
BocaSal Packet Mouth/Throat
BocaSal Packet Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
BocaSal Packet Mouth/Throat
BocaSal Packet Mouth/Throat

Artificial Saliva

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Caphosol Solution Mouth/Throat
Caphosol Solution Mouth/Throat

Artificial Saliva

Tier: 3
PA Type: No Prior Authorization
ST: N
Cavarest GEL 1.1 % DENTAL
Cavarest GEL 1.1 % DENTAL

Sodium Fluoride

Tier: 1
PA Type: No Prior Authorization
ST: N
Cavarest GEL 1.1 % DENTAL
Cavarest GEL 1.1 % DENTAL

Sodium Fluoride

Tier: 1
PA Type: No Prior Authorization
ST: N
Cavarest GEL 1.1 % DENTAL
Cavarest GEL 1.1 % DENTAL

Sodium Fluoride

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