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Number(s): 01-17-40, 02-17-35, 03-17-35, 08-17-42, 09-17-39, 11-17-35, 14-17-36, 24-17-36, 27-17-37, 30-17-36, 31-17-41, 32-17-35, 33-17-40
Issue Date: 12/27/2017
Effective Date: 01/08/2018
Subject: Prior Authorization of Austedo (deutetrabenazine) - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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