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Xiidra - Lifitegrast solution/ Drops
Capital District Physicians' Health Plan (CDPHP)
Capital District Physicians' Health Plan (CDPHP) Coverage for Xiidra - Lifitegrast solution/ Drops
All
6
Commercial
2
Health Exchange
2
Managed Medicaid
1
Medicare
1
Commercial
Commercial - HMO
No PA
No Step Therapy
Quantity Limit
See Details
Commercial - PPO
No PA
No Step Therapy
Quantity Limit
See Details
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
See Details
Health Exchange - HDHP - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details