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Prior authorization
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#	Item
321	Power Mobility Device (PMD) Demonstration Operational Guide[removed]Chapter 1: Power Mobility Device (PMD) Benefit Chapter 2: Healthcare Common Procedures Coding System (HCPCS) Codes Subject to the Prior Authorization Add to Reading List Source URL: www.cms.gov Language: English - Date: 2014-09-29 16:15:05 Medicare Presidency of Lyndon B. Johnson Healthcare Common Procedure Coding System Medicine Health Federal assistance in the United States Healthcare reform in the United States
322	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: 2012-09-26 09:31:11 Alcohols Phenols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Codeine Hydromorphone Clindamycin Chemistry Organic chemistry Morphinans
323	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM AVASTIN (bevacizumab) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Prescriber Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Bevacizumab Gastrointestinal cancer Renal cell carcinoma Lung cancer Glioblastoma multiforme Colorectal cancer Macular degeneration Medicine Orphan drugs Oncology
324	Prior Authorization of Power Mobility Devices (PMD) Demonstration Expansion: Executive Summary Updated August 14, 2014 Prior Authorization of Power Mobility Devices (PMDs) Add to Reading List Source URL: www.cms.gov Language: English - Date: 2014-09-16 18:13:22 Presidency of Lyndon B. Johnson Government Federal assistance in the United States Healthcare reform in the United States Medicare
325	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 12:26:04 Morphinans Combination drugs Anti-acne preparations Alcohols Phenols Tramadol Benzoyl peroxide Clindamycin Codeine Chemistry Organic chemistry Pharmacology
326	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: 2011-10-03 14:13:59 Morphinans Phenols Alcohols Ketones Tramadol Benzoyl peroxide Tapentadol Sulfacetamide/sulfur Clindamycin Chemistry Organic chemistry Anti-acne preparations
327	PRIOR AUTHORIZATION GROUP DESCRIPTION Add to Reading List Source URL: medicare.ghc.org Language: English - Date: 2014-11-05 14:35:15 Pharmaceuticals policy Managed care Clinical pharmacology Healthcare reform in the United States Medicare Medical prescription Carisoprodol Food and Drug Administration Prescription medication Health Medicine Pharmacology
328	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: 2012-06-27 09:53:24 Phenols Alcohols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Tapentadol Hydromorphone Sulfacetamide/sulfur Chemistry Organic chemistry Morphinans
329	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM ENBREL (enteracept)for JUVENILE IDIOPATHIC ARTHRITIS Patient name:_______________________________Medicaid ID #:________________________________ Prescriber Name Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:16 Immunosuppressants Pharmacology Arthritis Connective tissue diseases Etanercept Latent tuberculosis Biologic Juvenile idiopathic arthritis Medicine Health Rheumatology
330	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: 2013-12-16 08:52:17 Anti-acne preparations Alcohols Phenols Combination drugs Tramadol Clindamycin Sulfacetamide/sulfur Benzoyl peroxide Valsartan Chemistry Organic chemistry Morphinans

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