Sample Notes Page - CareFirst BlueCross BlueShield
Prescription Drug Detail

Brand Name
Brand Tier
Generic Name
Generic Tier
ADCIRCA
 
(Tier 3)
 
Not
Available
Not
Available

Prior Authorization Required: Yes
Quantity Limit: No
Category: Diseases\Pulmonary Arterial Hypertension
Maintenance Drug: Yes
Notes: This medication requires prior authorization. Please have your physician call 1-800-314-2872 before prescribing this medication.
Attachments: Adcirca.pdf