Non Preferred Drug With Continuation of Therapy - Medicaid

Prior Authorization

QP71-21 Provider Sharing of Protected Health Information (PHI) with Care Coordinators for Minnesota Health Care Program Members

BC-COM_PharmProgPolicyNotifctn_Eff 11.1.21_FINAL for posting.pdf

Triptan Agents - Medicaid

Quantity Limit

Topiramate Extended Release (ER) - Commercial

Prior Authorization, Quantity Limit

Jynarque® (tolvaptan) - Medicaid

Prior Authorization, Quantity Limit

Jynarque® (tolvaptan) - Commercial

Prior Authorization, Quantity Limit

Homozygous Familial Hypercholesterolemia (HoFH) Agents - Medicaid

Prior Authorization, Quantity Limit

Homozygous Familial Hypercholesterolemia (HoFH) Agents - Commercial

Prior Authorization, Quantity Limit

Endari™ (Pharmaceutical Grade L-Glutamine (PGLG)) - Medicaid

Prior Authorization