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Rebate Info

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Rebate Info

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Prior Authorization Criteria

PA Criteria Chart Effective June 1, 2025

PA Criteria Chart Effective April 1, 2025
PA Criteria Chart Effective April 1, 2025
PA Criteria Chart Effective January 1, 2025
PA Criteria Chart Effective January 1, 2025
PA Criteria Chart Effective October 1, 2024
PA Criteria chart - effective July 1, 2024
PA Criteria chart - Effective June 1, 2024
PA Criteria chart - Effective January 1, 2024

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