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Prescription Drug Benefits
Prescription Drug Benefits
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The prescription drug benefits below only apply to the Preferred Provider (PPB) Plans:
High-Performance Preferred Drug List (Plans A, B, C and D)
High-Performance Preventative Drug List (Plan C)
High-Performance Formulary Tier Listing
Retail Maintenance Network
Maintenance Medications List
Common Specialty Medications
Case Managed Drugs
Prior Authorizations/Drugs with Special Limitations
Prescription Drug Claim Form
Prescription Drug Claim Form (foreign)
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