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  Thursday, September 21, 2017
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Prior Approval Process

This section contains documentation related the Prior Approval Process.

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Prior Approval Process (11 rows returned) List

Prior Approval Process (11 rows returned)

 TitleFile TypeSize (KB)Release Date 
Synagis Policy Statement RSV Season 2016-2017PDF279.810/11/2016 
Atypical Antipsychotics PA Request Form PDF93.209/07/2016 
Multi-Ingredient Compound Drug PA Request FormPDF64.309/07/2016 
Proton Pump Inhibitors PA Request Form PDF148.601/04/2016 
Synagis PA Request FormPDF126.401/01/2016 
Nursing Facility Prior Authorization Issue Correction StepsPDF422.802/16/2015 
Tobacco Cessation PA Request FormPDF6605/01/2014 
Makena PA Summary PDF129.404/16/2014 
Georgia Watch FormPDF40.601/16/2013 
Non-Preferred Statin Request FormPDF121.901/16/2013 
PA Request Process GuidePDF131.310/24/2011 
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