GB Clear Springs-Enhanced PDP 5T 2021 CMP
XOFLUZA™ 20 mg tablet, packaged as 2 tablets for single dose of 40 mg, = $150.00; XOFLUZA™ 40 mg tablet, packaged as 2 tablets for single dose of 80 mg, = $150.00; ... TRAZODONE, AND TRICYCLIC ANTIDEPRESSANTS PRESCRIBED TO CHILDREN ≤ 3 YEARS OF AGE, EFFECTIVE MARCH 8, 2017: The current point of sale (POS) prior approval (PA) criteria for ... ................
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