Prescription & Pharmacy
Key Rx Formulary October 2022
Search Results
Displaying 1731 - 1740 of 3661 results
Provider
QP87-22 MHCP Pharmacy Benefit Update: New drug-related Prior Authorization (PA) Criteria: Strensiq® (asfotase alfa)
Program effective Date: Oct 26, 2022
Provider
QP86-22 MHCP Pharmacy Benefit Update: New drug-related Prior Authorization (PA) Criteria: Vtama® (tapinarof)
Program effective Date: Oct 26, 2022
Provider
QP84-22 MHCP Pharmacy Benefit Update: New drug-related Prior Authorization (PA) with Quantity Limit (QL) Criteria: Camzyos™ (mavacamten)
Program effective Date: Oct 26, 2022
Provider
QP85-22 MHCP Pharmacy Benefit Update: New drug-related Prior Authorization (PA) with Quantity Limit (QL) Criteria: Radicava® (edaravone)
Program effective Date: Oct 26, 2022
Provider
QP83-22 MHCP Pharmacy Benefit Exclusion for Somatuline® Depot and Sandostatin® LAR Depot
Program effective Date: Oct 26, 2022
Provider
Pyrukynd® (mitapivat) - Commercial - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Program effective Date: Feb 01, 2025
Provider
Ergotamine - Medicaid
Quantity Limit
Program effective Date: Aug 01, 2024
Provider
Ergotamine - Commercial
Quantity Limit
Program effective Date: Aug 01, 2024