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Number(s): 01-16-18, 09-16-17, 27-16-16, 02-16-16, 11-16-16, 30-16-16, 03-16-16, 14-16-16, 31-16-19, 08-16-17, 24-16-17, 32-16-15, 33-16-16
Issue Date: 06/13/2016
Effective Date: 06/13/2016
Subject: Prior Authorization of Xofigo (radium Ra 223 dichloride) - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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