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Number(s): 01-17-45, 02-17-40, 03-17-40, 08-17-47, 09-17-44, 11-17-40, 14-17-41, 24-17-41, 27-17-42, 30-17-41, 31-17-46, 32-17-40, 33-17-45
Issue Date: 12/27/2017
Effective Date: 01/08/2018
Subject: Prior Authorization of Xenazine (tetrabenazine) - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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