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Number(s): 01-18-32, 02-18-27, 03-18-28, 08-18-35, 09-18-33, 11-18-27, 14-18-28, 24-18-29, 27-18-32, 30-18-27, 31-18-33, 32-18-27, 33-18-32
Issue Date: 12/13/2018
Effective Date: 12/17/2018
Subject: Prior Authorization of Kalydeco (ivacaftor) – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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