131![MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES 1. Requirements for Prior Authorization of Soliris (eculizumab) A. MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES 1. Requirements for Prior Authorization of Soliris (eculizumab) A.](https://www.pdfsearch.io/img/cb1f5b607a0a602bc2cbe4d7df82b04a.jpg) | Add to Reading ListSource URL: www.dhs.state.pa.usLanguage: English - Date: 2014-12-29 17:37:38
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132![Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: ________________________________ Plan/Medical Group Phone#: (_______) Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: ________________________________ Plan/Medical Group Phone#: (_______)](https://www.pdfsearch.io/img/20d80a77c4819212f513b7f5c7614cce.jpg) | Add to Reading ListSource URL: www.dmhc.ca.govLanguage: English - Date: 2014-11-20 23:47:32
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133![Diabetic Supplies Preferred Product List Effective February 18, 2014 NOTE: The following diabetic supplies are available without Prior Authorization (PA). Meters Manufacturer Diabetic Supplies Preferred Product List Effective February 18, 2014 NOTE: The following diabetic supplies are available without Prior Authorization (PA). Meters Manufacturer](https://www.pdfsearch.io/img/bb604c1375cff16b30168d064df8ef63.jpg) | Add to Reading ListSource URL: kyportal.magellanmedicaid.comLanguage: English - Date: 2014-05-20 11:18:21
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134![Medicare Prior Authorization of Power Mobility Devices Demonstration Status Update (Posted[removed]The Medicare Prior Authorization of Power Mobility Devices (PMDs) Demonstration began on September 1, 2012 in Californ Medicare Prior Authorization of Power Mobility Devices Demonstration Status Update (Posted[removed]The Medicare Prior Authorization of Power Mobility Devices (PMDs) Demonstration began on September 1, 2012 in Californ](https://www.pdfsearch.io/img/096ef7dd265934767e49876a531b84df.jpg) | Add to Reading ListSource URL: www.cms.govLanguage: English - Date: 2014-09-18 18:12:42
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135![Medicare Prior Authorization of Power Mobility Devices Demonstration Status Update (Posted[removed]The Medicare Prior Authorization of Power Mobility Devices (PMDs) Demonstration began on September 1, 2012 in Califor Medicare Prior Authorization of Power Mobility Devices Demonstration Status Update (Posted[removed]The Medicare Prior Authorization of Power Mobility Devices (PMDs) Demonstration began on September 1, 2012 in Califor](https://www.pdfsearch.io/img/0c828b763c57a4baa91a73d5009b270d.jpg) | Add to Reading ListSource URL: www.cms.govLanguage: English - Date: 2014-12-30 14:13:11
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136![November 20, 2014 MAC Binder Section 13 – Miscellaneous Part B Table of Contents Request from the MAC Concerning a Common Prior Authorization Process Memo dated November 11, 2014 Certificate of Need Memo dated November 20, 2014 MAC Binder Section 13 – Miscellaneous Part B Table of Contents Request from the MAC Concerning a Common Prior Authorization Process Memo dated November 11, 2014 Certificate of Need Memo dated](https://www.pdfsearch.io/img/1cac2131e33bf1a74b528e949e0e7f1b.jpg) | Add to Reading ListSource URL: chfs.ky.gov- Date: 2015-01-17 10:58:20
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137![eBUREAU 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. Refer to cover eBUREAU 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. Refer to cover](https://www.pdfsearch.io/img/b9276fd51b0e68f7e8cd6aa5043195af.jpg) | Add to Reading ListSource URL: www.dhhr.wv.govLanguage: English - Date: 2014-12-11 08:18:17
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138![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. Refer to cover p 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. Refer to cover p](https://www.pdfsearch.io/img/39bad7ce0b45ac99399a9795fc5a500d.jpg) | Add to Reading ListSource URL: www.dhhr.wv.govLanguage: English - Date: 2014-12-19 11:58:30
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139![November 20, 2014 MAC Binder Section 13 – Miscellaneous Part B Table of Contents Request from the MAC Concerning a Common Prior Authorization Process Memo dated November 11, 2014 Certificate of Need Memo dated November 20, 2014 MAC Binder Section 13 – Miscellaneous Part B Table of Contents Request from the MAC Concerning a Common Prior Authorization Process Memo dated November 11, 2014 Certificate of Need Memo dated](https://www.pdfsearch.io/img/285255c7412752bdb3b1a3f840fe5f22.jpg) | Add to Reading ListSource URL: www.chfs.ky.gov- Date: 2015-01-17 10:58:21
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140![Findings from the February 2014 NCVHS Hearing on Prior Authorization for the Pharmacy Benefit; Health Plan Identifier (HPID); Electronic Fund Transfer (EFT)/Electronic Remittance Advice (ERA); and, Remaining Operating Ru Findings from the February 2014 NCVHS Hearing on Prior Authorization for the Pharmacy Benefit; Health Plan Identifier (HPID); Electronic Fund Transfer (EFT)/Electronic Remittance Advice (ERA); and, Remaining Operating Ru](https://www.pdfsearch.io/img/be04cf139f448f0e675a02b31f251397.jpg) | Add to Reading ListSource URL: www.ncvhs.hhs.govLanguage: English - Date: 2014-05-22 17:37:19
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