Standard Health Pals Formulary
Betamethasone Valerate 0.12% Foam (Generic for Luxiq)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply; Limit 100 grams in 30 days; Limit 300 grams in 90 days
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Luxiq