Ctexli - Medicaid

Prior Authorization, Quantity Limit

Qfitlia - Commercial

Prior Authorization, Quantity Limit

Qfitlia - Medicaid

Prior Authorization, Quantity Limit

Vanrafia - Commercial

Prior Authorization, Quantity Limit

Vanrafia - Medicaid

Prior Authorization, Quantity Limit

Vykat XR - Commercial

Prior Authorization, Quantity Limit

Vykat XR - Medicaid

Prior Authorization, Quantity Limit

QP113-25 Use of the TS Modifier

QP112-25 Prior Authorization for Ongoing Treatment of Chronic Conditions

QP111-25 Commercial Pharmacy Benefit Exclusion for Select Medications