Acute Migraine Agents - Commercial

Prior Authorization, Quantity Limit

QP92R1-21 Update: Federal Employee Program Plans Migration of Dental Coverage to United Concordia Dental

Hemlibra (emicizumab-kxwh) - Commercial

Prior Authorization, Quantity Limit

Gonadotropin Hormones - Commercial

Prior Authorization, Quantity Limit

Corticotropin - Medicaid - Effective Date 02/01/2025

Prior Authorization

Topical Antifungals - itraconazole, terbinafine - Medicaid

Prior Authorization, Quantity Limit

Topical Antifungals - itraconazole, terbinafine - Commercial

Prior Authorization, Quantity Limit

Antidepressant Agents - Commercial

Step Therapy, Quantity Limit

Thrombopoietin Receptor Agonists and Tavalisse - Medicaid

Prior Authorization, Quantity Limit

Thrombopoietin Receptor Agonists and Tavalisse - Commercial

Prior Authorization, Quantity Limit