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Number(s): 01-17-19, 02-17-17, 03-17-17, 08-17-19, 09-17-18, 11-17-17, 14-17-17, 24-17-17, 27-17-17, 30-17-18, 31-17-19, 32-17-17, 33-17-18
Issue Date: 04/27/2017
Effective Date: 05/01/2017
Subject: Prior Authorization of Ophthalmic Immunomodulators – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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