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Covermymeds. com For formulary information please visit the Florida Blue website at http //www. floridablue. Continued on the next page. FLCRUCialisPAQLFax6192AR0915 PRIME THERAPEUTICS LLC Page 1 of 2 Florida Blue and Florida Blue HMO Prescription Drug Benefits are administered by Prime Therapeutics our pharmacy benefit manager PBM. CIALIS PRIOR AUTHORIZATION ONLY the prescriber may complete this form. This form is for prospective concurrent and retrospective reviews. For BPH Has the patient...

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