Provider
QP67-23 Commercial Pharmacy Benefit Exclusion for Select Medications
Program effective Date: Aug 09, 2023
Program effective Date: Aug 09, 2023
Program effective Date: Aug 01, 2023
Program effective Date: Sep 01, 2023
Program effective Date: Aug 01, 2023
Program effective Date: Jul 26, 2023
Quantity Limit
Program effective Date: Nov 01, 2024
Prior Authorization, Quantity Limit
Program effective Date: May 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025