Note Title
Not Available Through Mail Service
Definition
This medication is not available through the mail service pharmacy
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LORCET HD 10/325
THERAPEUTIC CLASS: Hydrocodone Combinations
Select a strength to see details
10MG/325MG TABS
10MG/325MG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
Prior Authorization Forms
Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests
Massachusetts Standard Form for Medication Prior Authorization Requests
Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests
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