Provider
QP73-21 Medical Drug Update – RSV Health Alert and Palivizumab (Synagis)
Program effective Date: Sep 22, 2021
Program effective Date: Sep 22, 2021
Program effective Date: Sep 22, 2021
Program effective Date: Sep 22, 2021
Program effective Date: Sep 22, 2021
Quantity Limit
Program effective Date: Jun 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Sep 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Jun 01, 2025