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Number(s): 01-17-17, 02-17-15, 03-17-15, 08-17-16, 09-17-16, 11-17-15, 14-17-15, 24-17-15, 27-17-15, 30-17-16, 31-17-17, 32-17-15, 33-17-16
Issue Date: 01/31/2017
Effective Date: 01/31/2017
Subject: Prior Authorization of Xyrem (sodium oxybate) – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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