Ophthalmic Antihistamine - Commercial

Step Therapy

Non-Preferred Drug with Continuation of Therapy - Medicaid

Prior Authorization

Lupus - Commercial

Prior Authorization, Quantity Limit

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) - Commercial

Prior Authorization, Quantity Limit

Constipation Agents - Medicaid

Prior Authorization, Quantity Limit

Constipation Agents - Commercial

Prior Authorization, Quantity Limit

Compounded Medications - Commercial

Formulary Exception, Coverage Exception

Anti-Influenza Agents - Commercial

Quantity Limit

ARB/Renin Inhibitors - Commercial

Step Therapy, Quantity Limit

QP75-21 MHCP Pharmacy Benefit Update – New Drug-Related Prior Authorization (PA) with Quantity Limit (QL) Criteria: Weight Loss Agents