Agency of Health Care Administration

Drug Criteria

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 # A B C D e F G H I J K L M n O p Q r s T u V W X Y z

5-ASA Derivatives Criteria

Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys

Actemra

Adult High Dose Antipsychotic

Albumin

Aldurazyme

Alinia

Aloxi

Amitiza

Ampyra

Antidepressants (Age < 6 years)

Antipsychotic (Age 6 to <18)

Aplenzin

Apokyn

Aranesp

Arcalyst

Automated Prior Authorizations & Bypass

Banzel

Benlysta

Bone Resorption Inhibitor

Boniva Injection

Brisdelle

Buprenorphine Agents

Butalbital

Carbaglu

Cayston

Ceprotin

Chantix

Chorionic Gonadotropin

CII-V Edit Override

Cimzia

Lacrisert

Lamotrigine XR

Lioresal/Gablofen

Long Acting Beta 2 Agonists

Long Acting Stimulants in Children

Lovaza

Lumizyme

Makena

Marinol

Metadate CD

Methadone

Miscellaneous Drug

Miscellaneous Pharmacy Prior Authorization Requests

Morphine Sulfate ER

Multi Source Brand Drug

Multiple Sclerosis Oral Agents

Naglazyme

Namenda XR

Natacyn

Neumega

Neupogen/Leukine/Neulasta/Granix/Zarxio

Neupro

Nityr

Ofev

Off Label Use

Onfi

Opioid

Oral Oncology

Oravig

Orbactiv

Orencia

Orfadin

Orkambi

Otezla

Otrexup

Oxandrin

Oxtellar XR

Panretin

Praluent

ProCentra

Procrit

Procrit/Aranesp

Proleukin

Prolia

Pulmonary Hypertension Agent

Sabril

Samsca

Sancuso

Sandostatin LAR

Saphris

Sedative Hypnotic

 Selzentry

Sensipar

Serostim

Simponi

Sirturo

Soliris

Soma

Spinraza

No content available at this time.

Valcyte

Vecamyl

Venofer

Veregen

Vfend

Vibativ

Viberzi

No content available at this time.

Zyprexa Relprevv

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