Drugs for the Skin

BRAND NAME: Geri-Hydrolac 12 - generic.gif (400 bytes) Generic Available
Note: Brand name drugs are listed for reference only. The approval status and restrictions indicated below apply only to the brand's generic equivalent. Certain brand drugs may not be covered by your health plan. Please contact your health plan for additional information.

GENERIC NAME: 
ammonium lactate
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) preferred.gif (540 bytes)  
Cigna + Oscar notlisted.gif (324 bytes)  
Health Net notlisted.gif (324 bytes)  
Kaiser Foundation Health Plan Northern California notreimb.gif (645 bytes)  
Kaiser Foundation Health Plan Southern California notreimb.gif (645 bytes)  
Oscar notreimb.gif (645 bytes)  
Sharp Health Plan notlisted.gif (324 bytes)  
Sutter Health Plus notlisted.gif (324 bytes)  
UnitedHealthcare notlisted.gif (324 bytes)  
Western Health Advantage notlisted.gif (324 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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