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nevada medicaid and nevada checkup preferred drug list pdl effective january 1, 2017 pdl exception pa: https:www.medicaid.nv.govdownloadsproviderfa-63.pdf chapter 1200 pa…
© 2020 united healthcare services inc all rights reserved preferred drug list pdl rhode island effective date: 1120 unitedhealthcare community plan does not treat members…
please use the ndc drug lookup to find prior authorization pa forms preferred drug list pdl prior authorization criteria published by: medical services division north dakota…
© 2020 united healthcare services inc all rights reserved preferred drug list pdl new jersey effective date: 7120 unitedhealthcare community plan does not treat members…
ahcccs preferred drug list changes effective january 1, 2020 1172019 1 therapeutic class market basket national drug code ndc medispan medispan generic product indicator…
louisiana medicaid preferred drug list pdlnon-preferred drug list npdl http:ldh.la.govassetshealthylapharmacypdl.pdf • the pdl is a list of over 100 therapeutic classes…
© 2018 united healthcare services, inc. all rights reserved. preferred drug list (pdl) louisiana effective date: 7/1/18 unitedhealthcare community plan does not treat members…
state of michigan department of management and budget purchasing operations request for proposal number 071i9200185 pharmacy benefits manager services (pbm) for medicaid…
1 140303_md healthchoice pdl maryland healthchoice preferred drug list last update: 6/4/2019 this is a list of preferred outpatient and self-administered drugs (the pdl)…
state of wisconsin dhs 107102 wis admin code department of health services division of medicaid services f-00622 062012 forwardhealth prior authorization preferred drug list…
north dakota medicaid preferred drug list pdl prior authorization criteria published by: medical services division north dakota department of human services 600 e boulevard…
ar = age restriction, clinical prior authorization required pa = clinical prior authorization required non-preferred medications require prior authorization ql = quantity…
state of wisconsin dhs 107102 wis admin code department of health services division of medicaid services f-00433 072013 forwardhealth prior authorization preferred drug list…
nevada medicaid and nevada check up preferred drug list pdl effective february 5 2018 pdl exception pa: https:wwwmedicaidnvgovdownloadsproviderfa-63pdf chapter 1200 pa criteria:…
illinois medicaid preferred drug list effective january 1 2020 � the preferred drug list pdl has products listed in groups by drug class drug name dosage form and pdl status…
proprietary & confidential © 2017 magellan health, inc. louisiana medicaid preferred drug list program overview and results january 15, 2017 page 2 | louisiana medicaid…
stars sunshinehealthcom comprehensive preferred drug list page 2 last updated 122016 preferred drug list the sunshine health preferred drug list pdl is a guide to available…
department of health services state of wisconsin division of health care access and accountability dhs 107.10(2), wis. admin. code f-00194 (07/13) forwardhealth prior authorization…
montana medicaid preferred drug list pdl revised july 8 2020 *indicates a generic is available without prior authorization this list may not include all available generic…
alaska medicaid preferred drug list pdl pdl group ps market basket bn rt drug type gnn str pdl status pdl status effective date status change from previous a androgenic agents…