Provider
QP38-26 MHCP Pharmacy Benefit Exclusion for Avopef™, Epioxa™ HD/Epioxa, Fesilty™, Midazolam, Photrexa®, and Wainua®
Program effective Date: May 27, 2026
Program effective Date: May 27, 2026
Program effective Date: May 27, 2026
Program effective Date: May 27, 2026
Program effective Date: May 27, 2026
Program effective Date: May 27, 2026
Formulary Exception, Coverage Exception
Program effective Date: Jun 01, 2026
Prior Authorization
Program effective Date: Jun 01, 2026
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2026
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2026
Prior Authorization
Program effective Date: Jun 01, 2026