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Prior authorization
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#	Item
301	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM EMBEDA (morphine sulfate/naltrexone) Patient name:_______________________________Medicaid ID #:________________________________ Prescriber Name:________________ Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:16 Opioid antagonists Ethers Morphinans Phenols Morphine/naltrexone Morphine Pharmacist Naltrexone Fax Chemistry Organic chemistry Opiates
302	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 Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2012-02-06 14:53:32 Phenols Alcohols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Tapentadol Hydromorphone Codeine Chemistry Organic chemistry Morphinans
303	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 Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2012-06-07 09:55:07 Phenols Alcohols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Tapentadol Sulfacetamide/sulfur Hydromorphone Chemistry Organic chemistry Morphinans
304	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 Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2013-02-26 12:11:30 Morphinans Alcohols Phenols Euphoriants Anti-acne preparations Tramadol Codeine Benzoyl peroxide Hydrocodone Chemistry Organic chemistry Medicine
305	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 Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2013-06-03 10:22:15 Anti-acne preparations Alcohols Phenols Ketones Tramadol Benzoyl peroxide Clindamycin Codeine Hydrocodone Chemistry Organic chemistry Morphinans
306	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 Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2013-03-04 08:40:35 Morphinans Alcohols Phenols Euphoriants Anti-acne preparations Tramadol Codeine Benzoyl peroxide Hydrocodone Chemistry Organic chemistry Medicine
307	BUREAU FOR MEDICAL SERVICES WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA THERAPEUTIC PREFERRED AGENTS Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2010-12-03 12:25:59 Morphinans Combination drugs Anti-acne preparations Ketones Alcohols Benzoyl peroxide Hydrochlorothiazide Clindamycin Tramadol Chemistry Organic chemistry Pharmacology
308	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM ALOXI (palonostron hcl) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Prescrib Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Antiemetics Ketones Oncology Lactams Dolasetron Indoles Granisetron Palonosetron Ondansetron Medicine Chemistry Organic chemistry
309	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM ANDROGENS (all dosage forms) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Pre Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Androgens Testosterone Reproductive system Alkynes Danazol Steroids Hereditary angioedema Hypogonadism Endocrine system Medicine Endocrinology
310	Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Special Open Door Forum: Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport Wednesday, October 22, 2014 1:00- Add to Reading List Source URL: www.cms.gov Language: English - Date: 2014-10-20 20:12:48 United States Department of Health and Human Services Health Medicare Government Medicaid Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation Healthcare reform in the United States Federal assistance in the United States Presidency of Lyndon B. Johnson

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