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Lupron Depot
Mass General Brigham Health Plan (MCO)
Mass General Brigham Health Plan (MCO) Coverage for Lupron Depot
All
7
Commercial
2
Health Exchange
2
Managed Medicaid
1
Medicare
2
Commercial
Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
See Details
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
See Details
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
No Quantity Limit
See Details
Medicare - Prescription Drug Plan
PA Required
No Step Therapy
Quantity Limit
See Details
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