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Number(s): 01-19-02, 02-19-01, 03-19-01, 08-19-03, 09-19-02, 11-19-01, 14-19-01, 24-19-01, 27-19-01, 30-19-01, 31-19-02, 32-19-01, 33-19-02
Issue Date: 01/21/2019
Effective Date: 01/22/2019
Subject: Prior Authorization of Symdeko (tezacaftor/ivacaftor) – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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