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Dihydroergotamine Mesylate - Dihydroergotamine Mesylate injection, Solution
Blue Cross Blue Shield of Michigan (MCO)
Blue Cross Blue Shield of Michigan (MCO) Coverage for Dihydroergotamine Mesylate - Dihydroergotamine Mesylate injection, Solution
All
6
Commercial
2
Health Exchange
1
Managed Medicaid
1
Medicare
2
Commercial
Commercial - PPO
No PA
No Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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