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Number(s): 01-19-03, 02-19-02, 03-19-02, 08-19-04, 09-19-03, 11-19-02, 14-19-02, 24-19-02, 27-19-02, 30-19-02, 31-19-03, 32-19-02, 33-19-03
Issue Date: 01/21/2019
Effective Date: 01/22/2019
Subject: Prior Authorization of Radicava (edaravone) – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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