| Health Net |
| Dexilant (dexlansoprazole) |
| Drugs for the Stomach : Drugs for Ulcers and Stomach Acid |
- Step Therapy Applies
- Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 plan year
Reauthorization Required: Yes
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