Drugs for Addiction
Drugs for Smoking Addiction

BRAND NAME: nicotine (polacrilex)

GENERIC NAME: 
nicotine (polacrilex)
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) preferred.gif (540 bytes)  
Cigna + Oscar preferred.gif (540 bytes) NOTES.gif (377 bytes)
Health Net preferred.gif (540 bytes) NOTES.gif (377 bytes)
Kaiser Foundation Health Plan Northern California preferred.gif (540 bytes) NOTES.gif (377 bytes)
Kaiser Foundation Health Plan Southern California preferred.gif (540 bytes) NOTES.gif (377 bytes)
Oscar preferred.gif (540 bytes) NOTES.gif (377 bytes)
Sharp Health Plan preferred.gif (540 bytes) NOTES.gif (377 bytes)
Sutter Health Plus preferred.gif (540 bytes) NOTES.gif (377 bytes)
UnitedHealthcare approved.gif (510 bytes) NOTES.gif (377 bytes)
Western Health Advantage preferred.gif (540 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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