Hormones
Drugs for Women

BRAND NAME: Triptodur

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