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  Monday, December 10, 2018
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Prior Approval Process

This section contains documentation related the Prior Approval Process.

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Prior Approval Process (13 rows returned) List
 
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Prior Approval Process (13 rows returned)

 
 TitleFile TypeSize (KB)Release Date 
Atypical Antipsychotics PA Request Form PDF192.509/05/2018 
Emflaza Prior Authorization Request FormPDF159.509/05/2018 
Georgia Watch FormPDF152.809/05/2018 
HCV Re-Treatment PA Request FormPDF47.109/05/2018 
Non-Preferred Statin Request FormPDF157.809/05/2018 
Proton Pump Inhibitors PA Request Form PDF106.909/05/2018 
Tobacco Cessation PA Request FormPDF124.509/05/2018 
Synagis Policy Statement RSV Season 2018-2019PDF220.308/30/2018 
Medicaid Fee-For-Service Pharmacy Prior Authorization Request Process GuidePDF278.808/16/2018 
Multi-Ingredient Compound Drug PA Request FormPDF115.810/31/2017 
Nursing Facility Prior Authorization Issue Correction StepsPDF422.802/16/2015 
Makena PA Summary PDF129.404/16/2014 
Non-Preferred Statin Request FormPDF121.901/16/2013 
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