Sutter Health Plus
Doryx (doxycycline hyclate)
Drugs for Infections : Antibiotics
  • Quantity Limit: 6 tablets per 1 day(s).
  • Prior Authorization: CIDP: Immune Globulin:
    PA Applies Immune Thrombocytopenic Purpura (ITP), PID: Immune Globulin:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

    Pemphigus Vulgaris:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

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