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Bravo Health Prior Authorization Criteria

Drugs that require Prior Authorization (PA) before being approved for coverage:

• Bravo Achieve

• Bravo Choice

• Bravo Classic

• Bravo Classic Plus

• Bravo Freedom

• Bravo Liberty II Rx

• Bravo Premier

• Bravo Premier Plus

• Bravo Traditions

• Bravo Select

• Bravo Silver

• BravoRx

• Senior Partners Gold Rx

• Senior Partners Silver