Prior Approval Process

Tuesday, July 16, 2019

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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

»	Prior Approval Process (13 rows returned)

Atypical Antipsychotics PA Request Form

PDF

192.5

09/05/2018

Emflaza Prior Authorization Request Form

PDF

159.5

09/05/2018

Georgia Watch Form

PDF

152.8

09/05/2018

HCV Re-Treatment PA Request Form

PDF

47.1

09/05/2018

Non-Preferred Statin Request Form

PDF

157.8

09/05/2018

Proton Pump Inhibitors PA Request Form

PDF

106.9

09/05/2018

Tobacco Cessation PA Request Form

PDF

124.5

09/05/2018

Synagis Policy Statement RSV Season 2018-2019

PDF

220.3

08/30/2018

Medicaid Fee-For-Service Pharmacy Prior Authorization Request Process Guide

PDF

278.8

08/16/2018

Multi-Ingredient Compound Drug PA Request Form

PDF

115.8

10/31/2017

Nursing Facility Prior Authorization Issue Correction Steps

PDF

422.8

02/16/2015

Makena PA Summary

PDF

129.4

04/16/2014

Non-Preferred Statin Request Form

PDF

121.9

01/16/2013

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Prior Approval Process (13 rows returned)