Hormones
Drugs for Growth

BRAND NAME: Zomacton (for Zoma-Jet 10)

GENERIC NAME: 
somatropin No Generic Available
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) nonform.gif (625 bytes) NOTES_restrict.gif (377 bytes)
Cigna + Oscar notlisted.gif (324 bytes)  
Health Net priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Northern California approved.gif (510 bytes)  
Kaiser Foundation Health Plan Southern California nonform.gif (625 bytes)  
Oscar notreimb.gif (645 bytes)  
Sharp Health Plan notlisted.gif (324 bytes)  
Sutter Health Plus approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
UnitedHealthcare notreimb.gif (645 bytes)  
Western Health Advantage approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.
nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

 Notes or
Restrictions

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