5-ASA Derivatives Criteria
Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys
Actemra
Adult High Dose Antipsychotics
Albumin
Aldurazyme
Alinia
Aloxi
Amitiza
Ampyra
Antidepressants (Age < 6 years)
Antipsychotic (Age 6 to <18)
Aplenzin
Arcalyst
Automated Prior Authorizations & Bypass
Bone Resorption Inhibitor
Boniva Injection
Brisdelle
Buprenorphine Agents
Butalbital Criteria
Chorionic Gonadotropin
CII-V Edit Override
Dibenzyline
Dificid
Dupixent
Edurant
Elaprase
Exondys 51
Fuzeon
Hepatitis C Agents
Hetlioz
Lacrisert
Lamotrigine XR
Lioresal/Gablofen
Long Acting Beta 2 Agonists
Long Acting Stimulants in Children
Lovaza
Makena
Marinol
Metadate CD
Methadone
Miscellaneous Drugs
Miscellaneous Pharmacy Prior Authorization Requests
Multi Source Brand Drug
Multiple Sclerosis Oral Agents
Natacyn
Neumega
Neupogen/Leukine/Neulasta/Granix/Zarxio
Neupro
Onfi
Opioid
Oral
Oncology
Oravig
Oxandrin
Oxtellar XR
Oxycontin
ProCentra
Procrit
Procrit/Aranesp
Proleukin
Proton Pump Inhibitors
Pulmonary Hypertension Agent
Qudexy XR
Sabril
Samsca
Sancuso
Sandostatin LAR
Saphris
Sedative Hypnotic
Selzentry
Sensipar
Serostim
Simponi
Soma
Spinraza
Synribo Criteria
Taltz
Testosterone
No content available at this time.
Valcyte
Vecamyl
Venofer
Veregen
Vfend
Vibativ
Vimizim
No content available at this time.
Zortress
Zyprexa
Zyvox
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