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Number(s): 01-18-30, 02-18-25, 03-18-26, 08-18-33, 09-18-31, 11-18-25, 14-18-26, 24-18-27, 27-18-30, 30-18-25, 31-18-31, 32-18-25, 33-18-30
Issue Date: 12/13/2018
Effective Date: 12/17/2018
Subject: Prior Authorization of Hypoglycemics, Insulin and Related Agents – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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