| Anthem Blue Cross (HMO, PPO, EPO) |
| dexlansoprazole (dexlansoprazole) |
| Drugs for the Stomach : Drugs for Ulcers and Stomach Acid |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Quantity Limit: 30 day supply per 1 fill(s).
- PA Required
- Quantity Limit: 4 tablets per 1 day(s).
- Preventive Drug: Zero copay.
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