| Sutter Health Plus |
| Vanatol LQ (butalbital-acetaminophen-caff) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Quantity Limit: limit maximum 9 ML PER 1 day(s)
- Step Therapy: Pulmonary Arterial Hypertension:
ST Multiple Generics
- Quantity Limit: 1 tablet per 1 day(s).
- Prior Authorization: ADHD:
Documented Diagnosis: Yes
Age Requirement: >= 6
Duration: 1 plan year
Reauthorization Required: Yes
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