Approved Drug Utilization Review Board Edits
The reimbursement rate has a wide variance for the 5,000 mcg/10 ml strength, ranging from $9.40 to $22.70 per ml; the 1000 mcg/10 ml strength ranges from $1.92 to $4.54 per ml. Manual Review PA will be required for all requests for clonidine HCl PF vials and will be reviewed on a case-by-case basis. ................
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