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Number(s): 01-17-41, 02-17-36, 03-17-36, 08-17-43, 09-17-40, 11-17-36, 14-17-37, 24-17-37, 27-17-38, 30-17-37, 31-17-42, 32-17-36, 33-17-41
Issue Date: 12/27/2017
Effective Date: 01/08/2018
Subject: Prior Authorization of Brineura (cerliponase alfa) - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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