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Prior authorization
Results: 1240

#	Item
231	Maine CDC WIC Nutrition Program/MaineCare Request/Prior Authorization for Medical Formula/WIC-Eligible Nutritionals Return form to: Healthcare Provider: Address: Add to Reading List Source URL: www.maine.gov Language: English - Date: 2014-10-02 07:58:17 Enfamil Federal assistance in the United States United States Department of Agriculture WIC Breast milk Infant formula Behavior Breastfeeding Infant feeding Nutrition Food and drink
232	PHYSICIAN’S REQUEST FOR MEDICATION PRIOR AUTHORIZATION 1600 East Century Avenue, Suite 1 PO Box 5585 Add to Reading List Source URL: www.workforcesafety.com Language: English - Date: 2014-10-14 11:31:23 Medical terms Pharmacology Adverse effect Medicine Health Patient safety
233	2014 Prior Authorization for OPERS, Non-Medicare Prior Authorization Drug (If the drug you take is on this list, Express Scripts will check to make sure it meets your plan’s conditions for coverage.) Abstral Add to Reading List Source URL: www.opers.org Language: English - Date: 2014-01-21 10:53:06 Antivirals Anti-acne preparations Combination drugs Protease inhibitors Interferon Diclofenac Clindamycin/tretinoin Peginterferon alfa-2a Tretinoin Pharmacology Medicine Cytokines
234	RELISTOR™ PRIOR AUTHORIZATION REQUEST PHARMACY DIVISION SFN[removed]) Add to Reading List Source URL: www.workforcesafety.com Language: English - Date: 2014-09-09 15:21:35 Pharmacy Health Compliance Electronic prescribing Medicine Medical terms Pharmacology
235	Passport Health Plan Prior Authorization Form Synagis® Add to Reading List Source URL: www.passporthealthplan.com Language: English - Date: 2014-11-03 08:41:59 Clinical pharmacology Medical prescription Patient safety Pharmacology Pharmacy Palivizumab Medical diagnosis Pulmonary hypertension Medicine Health Medical terms
236	outpatient Medicaid Complete and Fax to: [removed]Prior Authorization Fax Form Request for additional units. Existing Authorization Add to Reading List Source URL: www.nhhealthyfamilies.com Language: English - Date: 2014-11-05 11:42:38 Medical informatics Healthcare Common Procedure Coding System Health Insurance Portability and Accountability Act International Statistical Classification of Diseases and Related Health Problems ICD-10 Superbill Current Procedural Terminology Medicine Health Medical classification
237	Suboxone Prior Authorization Form - Provider Letter - Passport Health Plan Add to Reading List Source URL: www.passporthealthplan.com Language: English - Date: 2014-04-09 15:31:48 Alcohols Morphinans Buprenorphine Ethers Phenols DEA number Opioid dependence Health Insurance Portability and Accountability Act Methadone Chemistry Drug rehabilitation Organic chemistry
238	PA Criteria Prior Authorization Group Drug Names Covered Uses Exclusion Criteria Required Medical Information Add to Reading List Source URL: www.bcidaho.com Language: English - Date: 2014-10-01 01:21:37 Eli Lilly and Company Clinical pharmacology Amines Immunosuppressants Methadone Food and Drug Administration Leflunomide Chemistry Pharmacology Pharmaceutical sciences
239	2014 Prior Authorization for OPERS, Medicare Members Prior Authorization Drug (If the drug you take is on this list, Express Scripts will check to make sure it meets your plan’s conditions for coverage.) Brand Name Add to Reading List Source URL: www.opers.org Language: English - Date: 2014-07-09 12:49:55 Cytokines Antivirals Protease inhibitors Interferon Peginterferon alfa-2a Peginterferon alfa-2b Telaprevir Boceprevir Adalimumab Medicine Biology Pharmacology
240	BUREAU FOR MEDICAL SERVICES WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA This is not an all-inclusive list of available covered drugs and includes only managed categories Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2010-12-30 09:45:38 Anti-acne preparations Morphinans Combination drugs Alcohols Phenols Sulfacetamide/sulfur Clindamycin Hydromorphone Tramadol Chemistry Organic chemistry Medicine

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