Provider
P63-17 New Drug-Related PA with Quantity Limit Criteria: Otezla (apremilast)
Program effective Date: Nov 06, 2017
Documents & Forms Results
Displaying 2321 - 2330 of 3704 results
Provider
P63-16 Drug Related Prior Authorization Criteria Changes for Ampyra, H.P. Acthar Gel, Transmucosal Fentanyl, Growth Hormone, and Oral Pulmonary Arterial Hypertension Agents
Program effective Date: Dec 20, 2016
Provider
P31-17 New Drug-Related Prior Authorization (PA) with Quantity Limit (QL) Criteria: Thrombopoietin Receptor Agents
Program effective Date: Jun 05, 2017
Provider
P57-17 Addition of Drugs to the Self-Administered Oncology Prior Authorization with Quantity Limit Program
Program effective Date: Oct 24, 2017
Provider
P39-17 Concurrent Review for Inpatient Hospital Services at Select Facilities
Program effective Date: Jul 11, 2017
Provider
P62-16 EY Modifier for Platinum Blue Subscribers
Program effective Date: Dec 13, 2016
Provider
P32-16 New Drug-Related Prior Authorization Criteria with Quantity Limit for Kuvan
Program effective Date: Jul 27, 2016
Provider
P42-16 Change in Medical Policy and Commercial Benefit Coverage of Cologuard Colorectal Cancer Screening Test
Program effective Date: Aug 08, 2016
Provider
P1-17 Prior Authorization Requirement for Gender Dysphoria
Program effective Date: Jan 18, 2017
Provider
P44-16 Addition of a Drug (Viekira XR) to the Hepatitis C Second Generation Prior Authorization with Quantity Limit Program
Program effective Date: Sep 01, 2016