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Acyclovir - Acyclovir capsule
Jefferson Health Plans (MCO)
Jefferson Health Plans (MCO) Coverage for Acyclovir - Acyclovir capsule
All
4
Health Exchange
2
Managed Medicaid
1
Medicare
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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Does Jefferson Health Plans Cover Acyclovir? 4 Plans (2026)