Financial Information
Provider
medicaid-gc-079-hair-removal-for-gender-affirming-procedures.pdf
Quantity Limit
Program effective Date: Jun 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2025
Quantity Limit
Program effective Date: Jun 01, 2025
Quantity Limit
Program effective Date: Jun 01, 2025
Step Therapy, Quantity Limit
Program effective Date: Jun 01, 2025