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​Pharmacy Prior Authorization Clinical Guidelines

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Doc Num ⇧Title ⇳Alphabetic ⇳Category ⇳Field1 ⇳Field2 ⇳
  Acne Agents, Oral AStatewide PDL Prior Authorization Guidelines  
  Acne Agents, Topical AStatewide PDL Prior Authorization Guidelines  
  Alpha-1 Proteinase Inhibitors AFFS Non-PDL Prior Authorization Guidelines  
  Alzheimer's Agents AStatewide PDL Prior Authorization Guidelines  
  Analgesics, Non-Opioid Barbiturate Combinations AStatewide PDL Prior Authorization Guidelines  
  Androgenic Agents AStatewide PDL Prior Authorization Guidelines  
  Angiotensin Modulator Combinations AStatewide PDL Prior Authorization Guidelines  
  Angiotensin Modulators AStatewide PDL Prior Authorization Guidelines  
  Anti-Allergens, Oral AFFS Non-PDL Prior Authorization Guidelines  
  Antianginal Agents (formerly Ranexa and Vasodilators, Coronary) AStatewide PDL Prior Authorization Guidelines  
  Antibiotics, Topical AStatewide PDL Prior Authorization Guidelines  
  Anticoagulants AStatewide PDL Prior Authorization Guidelines  
  Antidepressants, Other AStatewide PDL Prior Authorization Guidelines  
  Antidepressants, SSRIs AStatewide PDL Prior Authorization Guidelines  
  Antiemetics-Antivertigo Agents AStatewide PDL Prior Authorization Guidelines  
  Antifungals, Oral AStatewide PDL Prior Authorization Guidelines  
  Antihemophilia Agents AStatewide PDL Prior Authorization Guidelines  
  Antihistamines, Minimally Sedating AStatewide PDL Prior Authorization Guidelines  
  Antihypertensives, Sympatholytic AStatewide PDL Prior Authorization Guidelines  
  Antihyperuricemics AStatewide PDL Prior Authorization Guidelines  
  Antimalarials AStatewide PDL Prior Authorization Guidelines  
  Antimigraine Agents, Other AStatewide PDL Prior Authorization Guidelines  
  Antimigraine Agents, Triptans AStatewide PDL Prior Authorization Guidelines  
  Antiparasitics, Topical AStatewide PDL Prior Authorization Guidelines  
  Antipsoriatics, Oral AStatewide PDL Prior Authorization Guidelines  
  Antipsoriatics, Topical AStatewide PDL Prior Authorization Guidelines  
  Antipsychotics AStatewide PDL Prior Authorization Guidelines  
  Antivirals, CMV AStatewide PDL Prior Authorization Guidelines  
  Antivirals, Herpes AStatewide PDL Prior Authorization Guidelines  
  Antivirals, Influenza AStatewide PDL Prior Authorization Guidelines  
  Benign Prostatic Hyperplasia (BPH) Treatments BStatewide PDL Prior Authorization Guidelines  
  Bladder Relaxant Preparations BStatewide PDL Prior Authorization Guidelines  
  Bone Density Regulators BStatewide PDL Prior Authorization Guidelines  
  Brineura (cerliponase alfa) BFFS Non-PDL Prior Authorization Guidelines  
  Bronchodilators, Beta Agonists BStatewide PDL Prior Authorization Guidelines  
  Colony Stimulating Factors CStatewide PDL Prior Authorization Guidelines  
  Complement Inhibitors (formerly Soliris) CFFS Non-PDL Prior Authorization Guidelines  
  Compounded Prescriptions CFFS Non-PDL Prior Authorization Guidelines  
  Contraceptives, Oral CStatewide PDL Prior Authorization Guidelines  
  Contraceptives, Other CStatewide PDL Prior Authorization Guidelines  
  COPD Agents CStatewide PDL Prior Authorization Guidelines  
  Corlanor (ivabradine) CFFS Non-PDL Prior Authorization Guidelines  
  Cough and Cold Medications CFFS Non-PDL Prior Authorization Guidelines  
  Diabetic Meters DStatewide PDL Prior Authorization Guidelines  
  Diabetic Strips DStatewide PDL Prior Authorization Guidelines  
  Early Refills of Prescriptions EFFS Non-PDL Prior Authorization Guidelines  
  Emollients EStatewide PDL Prior Authorization Guidelines  
  Epinephrine, Self-Injected EStatewide PDL Prior Authorization Guidelines  
  Erythropoiesis Stimulating Proteins EStatewide PDL Prior Authorization Guidelines  
  Estrogens EStatewide PDL Prior Authorization Guidelines  
  Fluoroquinolones, Oral FStatewide PDL Prior Authorization Guidelines  
  G.I. Motility, Chronic Agents GStatewide PDL Prior Authorization Guidelines  
  Glucocorticoids, Inhaled GStatewide PDL Prior Authorization Guidelines  
  Glucocorticoids, Oral GStatewide PDL Prior Authorization Guidelines  
  Growth Factors GFFS Non-PDL Prior Authorization Guidelines  
  Growth Hormones GStatewide PDL Prior Authorization Guidelines  
  H. Pylori Treatments HStatewide PDL Prior Authorization Guidelines  
  H.P. Acthar Gel (corticotropin) HFFS Non-PDL Prior Authorization Guidelines  
  Histamine 2 Receptor Blockers HStatewide PDL Prior Authorization Guidelines  
  HIV AIDS Antiretrovirals HStatewide PDL Prior Authorization Guidelines  
  Hypoglycemics, Alpha-Glucosidase Inhibitors HStatewide PDL Prior Authorization Guidelines  
  Hypoglycemics, Meglitinides HStatewide PDL Prior Authorization Guidelines  
  Hypoglycemics, Metformins HStatewide PDL Prior Authorization Guidelines  
  Hypoglycemics, Sulfonylureas HStatewide PDL Prior Authorization Guidelines  
  Immune Globulins IFFS Non-PDL Prior Authorization Guidelines  
  Immunomodulators, Topical IStatewide PDL Prior Authorization Guidelines  
  Immunosuppressives, Oral IStatewide PDL Prior Authorization Guidelines  
  Intranasal Rhinitis Agents IStatewide PDL Prior Authorization Guidelines  
  Iron Chelating Agents IStatewide PDL Prior Authorization Guidelines  
  Iron, Oral IStatewide PDL Prior Authorization Guidelines  
  Iron, Parenteral IStatewide PDL Prior Authorization Guidelines  
  Kalydeco (ivacaftor) KFFS Non-PDL Prior Authorization Guidelines  
  Lipotropics, Statins LStatewide PDL Prior Authorization Guidelines  
  Local Anesthetics, Topical LStatewide PDL Prior Authorization Guidelines  
  Macrolides MStatewide PDL Prior Authorization Guidelines  
  Monoclonal Antibodies – Anti-IL, Anti-IgE MStatewide PDL Prior Authorization Guidelines  
  Mozobil (plerixafor) MFFS Non-PDL Prior Authorization Guidelines  
  Multiple Sclerosis Agents MStatewide PDL Prior Authorization Guidelines  
  Nuedexta (dextromethorphan-quinidine) NFFS Non-PDL Prior Authorization Guidelines  
  Oncology Agents, Breast Cancer OStatewide PDL Prior Authorization Guidelines  
  Ophthalmics, Antibiotics OStatewide PDL Prior Authorization Guidelines  
  Ophthalmics, Antibiotic-Steroid Combinations OStatewide PDL Prior Authorization Guidelines  
  Ophthalmics, Anti-Inflammatories OStatewide PDL Prior Authorization Guidelines  
  Opioid Dependence Treatments OStatewide PDL Prior Authorization Guidelines  
  Orkambi (lumacaftor-ivacaftor) OFFS Non-PDL Prior Authorization Guidelines  
  Otic Anti Infectives and Anesthetics OStatewide PDL Prior Authorization Guidelines  
  Pancreatic Enzymes PStatewide PDL Prior Authorization Guidelines  
  Penicillins PStatewide PDL Prior Authorization Guidelines  
  Phosphate Binders PStatewide PDL Prior Authorization Guidelines  
  Platelet Aggregation Inhibitors PStatewide PDL Prior Authorization Guidelines  
  Potassium Removing Agents PStatewide PDL Prior Authorization Guidelines  
  Prenatal Vitamins PStatewide PDL Prior Authorization Guidelines  
  Progestational Agents PStatewide PDL Prior Authorization Guidelines  
  Proton Pump Inhibitors (PPIs) PStatewide PDL Prior Authorization Guidelines  
  Provenge (sipuleucel-T) PFFS Non-PDL Prior Authorization Guidelines  
  Quantity Limits-Daily Dose Limits QFFS Non-PDL Prior Authorization Guidelines  
  Radicava (edaravone) RFFS Non-PDL Prior Authorization Guidelines  
  Rilutek (riluzole) RFFS Non-PDL Prior Authorization Guidelines  
  Santyl Ointment (collagenase) SFFS Non-PDL Prior Authorization Guidelines  
  Skeletal Muscle Relaxants SStatewide PDL Prior Authorization Guidelines  
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