Bcn 2024 Formulary Tiers. The chart below shows the differences between the tiers. In total, 170 medications are part of the optum rx critical drug.

1‐877‐251‐5896 for the physician fax form, go to: Each covered drug is in 1 of 5 drug tiers.

1‐877‐251‐5896 For The Physician Fax Form, Go To:

Medications requiring participation in the fill this.

Www.bcbsla.com ≫ Provider ≫ Pharmacy.

Each covered drug is in 1 of 5 drug tiers.

The Enclosed Formulary Is Current As Of January 1, 2024.

Images References :

Each Tier Has A Copay Or Coinsurance Amount.

1‐877‐251‐5896 for the physician fax form, go to:

2024 Medicare Part D Formulary Tiers.

Each covered drug is in 1 of 5 drug tiers.

Each Covered Drug Is In 1 Of 5 Drug Tiers.