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Passport Health Plan
Passport Health Plan Coverage for Ubrelvy
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3
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1
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1
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1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
PA Required
Step Therapy
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
Step Therapy
Quantity Limit
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