Standard Health Pals Formulary
Zolmitriptan 2.5 mg Orally Disintegrating Tablet (ODT)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply; Max of 3 tablets for 30 days’ supply; Max of 9 tablets for 90 days’ supply.
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – N/A