All *PHARMACEUTICAL ADJUVANTS*

Auxipro Vanishing Cream External
Auxipro Vanishing Cream External

Cream Base

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Auxipro Vanishing Cream External
Auxipro Vanishing Cream External

Cream Base

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Auxipro Vanishing Cream External
Auxipro Vanishing Cream External

Cream Base

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Auxipro Vanishing Cream External
Auxipro Vanishing Cream External

Cream Base

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Bacteriostatic Water(Benz Alc) Solution Injection
Bacteriostatic Water(Benz Alc) Solution Injection

Tier: 3
PA Type: No Prior Authorization
ST: N
Bacteriostatic Water(Benz Alc) Solution Injection
Bacteriostatic Water(Benz Alc) Solution Injection

Tier: 3
PA Type: No Prior Authorization
ST: N
Cream Base Niosomes Cream External
Cream Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Cream Base Niosomes Cream External
Cream Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Cream Base Niosomes Cream External
Cream Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Cream-Heavy Base Niosomes Cream External
Cream-Heavy Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Cream-Heavy Base Niosomes Cream External
Cream-Heavy Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Cream-Heavy Base Niosomes Cream External
Cream-Heavy Base Niosomes Cream External

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N