Momenta Pharmaceuticals, Inc. (MNTA)

[Boing x 2]

I am sure this is just a sample. I was getting cross eyed going through the lists.

Another Glatopa added effective 9/1

Page 1

https://www.ucare.org/SiteCollectionDocuments/HealthPlans/UFS/2015/U6423A_WebsiteFormularyChangeAdditions_UFSGroup.pdf

Another effective 9/1 page 19,

http://preciserxcare.amwins.com/ldi/Documents/PreciseRxCare_4Tier_Changes.pdf

Added 8/25

https://www.azblue.com/~/media/azblue/files/pharmacy-forms-mastery-directory/all-other/other-forms-and-resources/specialty-drug-list.pdf

Added 9/1 page 27,

https://www.wpsic.com/partd/files/2015/S5753_26651_021_1407-pdp-formulary-Combined.pdf

NOTE Glatopa Tier 2 vs Copaxone Tier 5

Added 9/1 Top of page,

https://www.priorityhealth.com/medicare/once-you-enroll/drug-coverage/formulary-changes

Added 9/1 page 19

http://www.sterlingretireescripts.com/Documents/Base%20Sterling%20Formulary%20Changes.pdf

Added 9/1 page 2

https://www.mcsclassicare.com/en/Documents/Formulary3Ad2015.pdf

Note other drugs do not apply. i.e. Copaxone? Sole approval for Glatopa?

Added 9/1 page 14

https://www.uamedicarepartd.com/PDF/Formulary/UA_Essential_PriorAuthorization_2015.pdf

Added 9/1 page 37

http://coventry-medicare.coventryhealthcare.com/web/groups/public/@cvty_commoncontent/documents/webcontent/a302055.pdf

Added 9/1 page 24

https://www.partdkansascity.com/shop/content/olspublic/pdf/2015/english/PDP_ComForm_Pre_KC_MO.pdf

Added 9/1 page 74

https://www.modahealth.com/pdfs/odsadv/2015/formulary.pdf

Boing X 2