| Sutter Health Plus |
| Adlyxin Starter Pack (lixisenatide) |
| Hormones : Drugs for Diabetes |
- Prior Authorization: Low Testosterone:
PA Applies
- Quantity Limit: limit maximum 120 EA PER 30 day(s)
- Step Therapy: ST_APPLIES
- Step Therapy: ST_APPLIES
- Split Fill;
- Quantity Limit: limit maximum 30 day(s) supply
|