All *ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS*

AcipHex Sprinkle Capsule Sprinkle 10 MG Oral
AcipHex Sprinkle Capsule Sprinkle 10 MG Oral

RABEprazole Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
AcipHex Sprinkle Capsule Sprinkle 10 MG Oral
AcipHex Sprinkle Capsule Sprinkle 10 MG Oral

RABEprazole Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
AcipHex Sprinkle CAPSULE SPRINKLE 5 MG Oral
AcipHex Sprinkle CAPSULE SPRINKLE 5 MG Oral

RABEprazole Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
AcipHex Sprinkle CAPSULE SPRINKLE 5 MG Oral
AcipHex Sprinkle CAPSULE SPRINKLE 5 MG Oral

RABEprazole Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Aciphex Tablet Delayed Release 20 MG Oral
Aciphex Tablet Delayed Release 20 MG Oral

RABEprazole Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amoxicill-Clarithro-Lansopraz Oral
Amoxicill-Clarithro-Lansopraz Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Anaspaz TABLET DISPERSIBLE 0.125 MG ORAL
Anaspaz TABLET DISPERSIBLE 0.125 MG ORAL

Hyoscyamine Sulfate

Tier: 3
PA Type: No Prior Authorization
ST: N