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Number(s): 01-15-37, 02-15-29, 03-15-29, 08-15-35, 09-15-35, 11-15-28, 14-15-30, 24-15-30, 27-15-29, 30-15-28, 31-15-36, 32-15-29, 33-15-34
Issue Date: 11/10/2015
Effective Date: 10/26/2015
Subject: Prior Authorization of Kalydeco, Nuedexta and Xyrem - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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