Provider
Formulary Exception for FlexRx Formulary and GenRx Formulary
Formulary Exception
Program effective Date: Jan 01, 2026
Documents & Forms Results
Displaying 3291 - 3300 of 3704 results
Provider
Zokinvy (lonafarnib) - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2025
Provider
Imcivree - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025
Provider
Zokinvy (lonafarnib) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2025
Provider
Samsca (tolvaptan) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025
Provider
Hyperhidrosis - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Mar 01, 2026
Provider
Inhaled Antibiotics Duplicate Therapy - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Mar 01, 2026
Provider
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: Mar 01, 2026
Provider
Morphine Equivalent Dosing (MED) - Medicaid
Prior Authorization
Program effective Date: Sep 01, 2025
Provider
Wakix (pitolisant) - Medicaid
Prior Authorization, Quantity Limit
Program effective Date: Mar 01, 2026