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This is not a complete list of drugs covered under your plan. Check your plan documents for coverage information. Your plan may not cover certain drugs to treat conditions such as infertility, erectile dysfunction, and weight loss. Drug products are identified by unique numerical product identifiers, called National Drug Codes (NDC), which identify the manufacturer, strength, dosage form, formulation and package size. This listing does not include certain  NDCs. To check coverage and copay information for a specific medicine, log into your member website. If you’re still not sure whether your plan benefits include coverage, call the toll-free number on the back of your ID card.
Drug Search: dovato oral tablet 50-300 mg
1 drug(s) found
To view other medications in a therapeutic class, click any class hyperlink in your search results.

Results

Brand Name
Generic Name		Therapeutic Class
Sub-Class		Dose/StrengthStatusNotes & Restrictions
Dovato Oral Tablet 50-300 Mg
dolutegravir-lamivudineAnti-Infectives - Drugs To Treat Infections
Antiretroviral Combination Agents - Drugs To Suppress Hiv/Aids Infection		Anti-Infectives - Drugs To Treat Infections
Antiretroviral Combination Agents - Drugs To Suppress Hiv/Aids Infection		TABLET 50-300 MG

Definition of Status

IconStatusDefinition
GG

Generics
PBPB

Preferred Brands
NPBNPB

Non-Preferred Brands
PSPPSP

Preferred Specialty
NPSPNPSP

Non-Preferred Specialty
NFNFFormulary Excluded
CECECopay Exception:  Available to some members at no cost with a prescription from your provider when obtained at an in-network pharmacy.  Certain limitations may apply. 

Definition of Restrictions

IconRestrictionDefinition
IBCIBCIndication Based Coverage
LGCLGCLowest Generic Copay Applies
N8N8Drug Specific Coverage
SPCSPCSelect Plan Coverage: Only available for select plans.   Refer to member plan documents for coverage.