Provider
QP28-21 Commercial Pharmacy Benefit Exclusion for Select Medications and Formulary Alternatives
Program effective Date: Apr 14, 2021
Program effective Date: Apr 14, 2021
Program effective Date: Apr 28, 2021
Program effective Date: Apr 28, 2021
Program effective Date: Apr 01, 2021
Program effective Date: Apr 01, 2021
Program effective Date: Apr 01, 2021
Program effective Date: Apr 01, 2021
Prior Authorization
Program effective Date: Jun 01, 2024
Prior Authorization
Program effective Date: Nov 01, 2024
Prior Authorization, Quantity Limit
Program effective Date: Mar 01, 2025