Eliminate delaysWe have to call for more information on 40% of all prior authorization and medical necessity drug request forms!
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 Can't find a drug-specific form? Use the general Non-Covered Medication Prior Authorization Form AActharAmevive Amitiza - Medicare and Medicaid only Androgel - Androderm Antiemetic Medication Anti-Neoplastic Medication - Oral - Medicare only Aralast Aranesp - Medicare and Medicaid only (Use specialty order form for HMO, PPO, POS) BBonivaBotox Butorphanol Nasal Spray Byetta - Medicare and Medicaid only CCancidas - Medicare onlyCelebrex Chantix Concerta - Medicaid only Crestor DDaytrana - Medicaid onlyDispense as Written (DAW) EEnbrelEnteral Formulas Enteral Formulas - Medicare only Epogen Procrit - Medicare and Medicaid only (Use specialty order form for HMO, PPO, POS) Eraxis - Medicare only Erbitux FFabrazymeForteo - Medicare and Medicaid only GHHumiraHuman Growth Hormone Hyalurate IImmunosuppressive Drugs - Oral - Medicare onlyIncrelex Inhalation Solutions used with a nebulizer - Medicare only Intravenous 5-HT3 Antagonists (Anzemet, Kytril, and Aloxi) Intravenous Immunoglobin (IVIG) Iressa JJanuvia - Medicare and Medicaid onlyKKineretLLamisilLidoderm Lotronex - Medicare and Medicaid only Lovaza (formerly Omacor) Lupron Lyrica MMethylphenidate - Medicaid onlyMigraine Abortive Medication Multiple Sclerosis Mycamine - Medicare only Myobloc NNebuPentNeulasta and Neupogen - Medicare and Medicaid only (Use specialty order form for HMO, PPO, POS) Non-Covered Medication OOmacor -- see LovazaOrencia Oxycodone SR - Medicaid only P Pegasys
- Medicare and Medicaid only
Q
R Ranexa
- Medicare and Medicaid only
SSingulair - Medicare and Medicaid onlySporanox Symlin - Medicare and Medicaid only Synagis Supplemental Supply
T Tamiflu
U
VVaccines - Medicare only Vectibix
W
X Xenical - Medicaid only
YZZevalinZorbtive Zostavax - Medicare only Zyvox
Last modified
09/17/08
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