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  Wednesday, June 20, 2018
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Prior Approval Process

This section contains documentation related the Prior Approval Process.

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Prior Approval Process (12 rows returned) List

Prior Approval Process (12 rows returned)

 TitleFile TypeSize (KB)Release Date 
Atypical Antipsychotics PA Request Form PDF193.310/31/2017 
Georgia Watch FormPDF152.810/31/2017 
Multi-Ingredient Compound Drug PA Request FormPDF115.810/31/2017 
Proton Pump Inhibitors PA Request Form PDF107.310/31/2017 
Synagis PA Request FormPDF173.710/31/2017 
Tobacco Cessation PA Request FormPDF93.810/31/2017 
Emflaza Prior Authorization Request FormPDF133.910/17/2017 
Synagis Policy Statement RSV Season 2017-2018PDF221.310/12/2017 
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 
PA Request Process GuidePDF131.310/24/2011 
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