Anascorp SOLUTION RECONSTITUTED Intravenous
Centruroides (Scorpion) Im Fab
Tier: 3
PA Type: No Prior Authorization
ST: N
Anavip Solution Reconstituted Intravenous
Crotalidae Immune Fab (Equine)
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anavip Solution Reconstituted Intravenous
Crotalidae Immune Fab (Equine)
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Antivenin Micrurus Fulvius SOLUTION RECONSTITUTED Intravenous
Tier: 3
PA Type: No Prior Authorization
ST: N
Antivenin Micrurus Fulvius SOLUTION RECONSTITUTED Intravenous
Tier: 3
PA Type: No Prior Authorization
ST: N
Asceniv Solution 5 GM/50ML Intravenous
Immune Globulin (Human)-slra
Tier: Non-Formulary
PA Type: PA Applies
PA Group: Immunoglobulins
Asceniv Solution 5 GM/50ML Intravenous
Immune Globulin (Human)-slra
Tier: Non-Formulary
PA Type: PA Applies
PA Group: Immunoglobulins
Bamlanivimab Solution 700 MG/20ML Intravenous
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Bivigam Solution 5 GM/50ML Intravenous
Immune Globulin (Human)
Tier: 4
PA Type: PA Applies
PA Group: Immunoglobulins