All *THYROID AGENTS*

Armour Thyroid Tablet 120 MG Oral
Armour Thyroid Tablet 120 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid Tablet 15 MG Oral
Armour Thyroid Tablet 15 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid TABLET 180 MG ORAL
Armour Thyroid TABLET 180 MG ORAL

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid TABLET 240 MG Oral
Armour Thyroid TABLET 240 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid Tablet 30 MG Oral
Armour Thyroid Tablet 30 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid Tablet 300 MG Oral
Armour Thyroid Tablet 300 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid Tablet 60 MG Oral
Armour Thyroid Tablet 60 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Armour Thyroid Tablet 90 MG Oral
Armour Thyroid Tablet 90 MG Oral

Thyroid

Tier: 3
PA Type: No Prior Authorization
ST: N
Cytomel Tablet 25 MCG Oral
Cytomel Tablet 25 MCG Oral

Liothyronine Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Cytomel Tablet 5 MCG Oral
Cytomel Tablet 5 MCG Oral

Liothyronine Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Cytomel TABLET 50 MCG ORAL
Cytomel TABLET 50 MCG ORAL

Liothyronine Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Euthyrox Tablet 100 MCG Oral
Euthyrox Tablet 100 MCG Oral

Levothyroxine Sodium

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