Page 51 - PHP CA Resource Guide

Online it is the last one in the Northern Nevada directories.
If you are looking in QNXT under the provider section, the plan affiliation tab will display.
Tier 1 FDA approved oral contraceptives Tier 2 Generic
·Tier 3 Preferred Brand
·Tier 4 Non-Preferred Brand ·Tier 5 Specialty
QL: Quantity Limits; ST: Step Therapy; PA: Prior Authorization Required
If there is a RX classified under tier 5 and no PA by it that means it belongs to the “Protected Class” and no authorization will be required.
Care Advocate Resource Guide 2021 Q1-Q2
94
SLAITNESSE
SREIT TIFENEB YCAMRAHP LAICREMMOC
SEIROTCERID REDIVORP LAICREMMOC VNN