Aralast NP SOLUTION RECONSTITUTED 1000 MG Intravenous
Alpha1-Proteinase Inhibitor
Tier: 4
PA Type: PA Applies
PA Group: Alpha1 proteinase inhibitors
Aralast NP SOLUTION RECONSTITUTED 500 MG Intravenous
Alpha1-Proteinase Inhibitor
Tier: 4
PA Type: PA Applies
PA Group: Alpha1 proteinase inhibitors
Bronchitol Capsule 40 MG Inhalation
Mannitol
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Bronchitol Capsule 40 MG Inhalation
Mannitol
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Bronchitol Tolerance Test Capsule 40 MG Inhalation
Mannitol
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Curosurf SUSPENSION 120 MG/1.5ML Intratracheal
Poractant Alfa
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N