Provider
QP44-24 MHCP Pharmacy Benefit Exclusion for Anktiva® and Docivyx™
Program effective Date: May 22, 2024
Program effective Date: May 22, 2024
Program effective Date: May 22, 2024
Program effective Date: May 08, 2024
Program effective Date: May 08, 2024
Program effective Date: May 01, 2024
Program effective Date: May 01, 2024
Prior Authorization, Quantity Limit
Program effective Date: Nov 01, 2024
Step Therapy, Quantity Limit
Program effective Date: Feb 01, 2025
Quantity Limit
Program effective Date: Feb 01, 2025