Tus kws kho mob
Myalept® (metreleptin) - Commercial - Effective Date 02/01/2025
Prior Authorization
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Cov Ntaub Ntawv thiab Cov Txiaj Ntsig Ua Tau Los Ntawm Cov Foos
Nthuav pom cov txiaj ntsig tshwm sim 591 - 600 ntawm 3159
Tus kws kho mob
Topical NSAID (Non-Steroidal Anti-Inflammatory Drug) - Commercial - Effective Date 02/01/2025
Step Therapy, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Corticotropin - Medicaid - Effective Date 02/01/2025
Prior Authorization
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Atopic Dermatitis (Elidel®, Eucrisa™, Protopic®, tacrolimus) - Medicaid - Effective Date 02/01/2025
Step Therapy
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Atopic Dermatitis (Elidel®, Eucrisa™, Protopic®, tacrolimus) - Commercial - Effective Date 02/01/2025
Step Therapy
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Korlym™(mifepristone) - Commercial - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Proprotein Convertase Subtilisin/kexin type 9 (PCSK9) Inhibitors - Medicaid - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Proprotein Convertase Subtilisin/kexin type 9 (PCSK9) Inhibitors - Commercial - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Ohtuvayre™ - Medicaid - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025
Tus kws kho mob
Ohtuvayre™ - Commercial - Effective Date 02/01/2025
Prior Authorization, Quantity Limit
Hnub Tim pib siv tau lub khoos kas: Lub Ob Hlis Ntuj Tim 01, 2025