A formula status update for vigil (vigil) healthcare plan. It has a yellow background with a white circle on the right side. The title of the form is "formula Status Update" and it is written in black text. Below the title there is a table with three columns - UnitedHealthcare ballpoint/Anthem AETNA U.S. Healthcare Cigna Healthcare and triage Military Health System. The table is divided into three tiers - Tier 3 Tier 2 and Tier 3. Each tier has a different color scheme - orange yellow and green. The first tier has the title "UnitedHealthcare" written in bold black text followed by "ballpoint/Anthems" and "AETNA US Healthcare" in smaller text. The second tier has "Tier 2 (PA)" written in green text and the third tier has two (PA) written in orange text. At the bottom of the table there are two logos - "cephalic" on the bottom right corner. The table also has a note that reads "No additional prior authorization for patients who have a previously approved PA for prodigal" written on it.
Description 
Type
Category
Source 1 of 2
-
Date
2013
Collection
-
Date
2013
Collection
We encourage you to view the image in the context of its source document(s) and cite the source(s) when using these images. However, to cite just this image alone, click the “Cite This Image” button and then paste the copied text.
