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Number(s): 01-17-39, 02-17-34, 03-17-34, 08-17-41, 09-17-38, 11-17-34, 14-17-35, 24-17-35, 27-17-36, 30-17-35, 31-17-40, 32-17-34, 33-17-39
Issue Date: 12/27/2017
Effective Date: 01/08/2018
Subject: Prior Authorization of Ingrezza (valbenazine) - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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