Tier: 1
Prior Authorization: 1
Step Therapy: 0
Category: GASTROINTESTINAL AGENTS
Sub Category: GASTROINTESTINAL AGENTS, OTHER
NDC:
Tier: 1
Tier: 1
Prior Authorization: 1
Step Therapy: 0
Category: GASTROINTESTINAL AGENTS
Sub Category: GASTROINTESTINAL AGENTS, OTHER
NDC:
Tier: 1
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