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Prior authorization
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#	Item
351	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM CIMZIA (certolizumab) for Rheumatoid or Psoriatic Arthritis Patient name:___________________________________Medicaid ID #:________________________________ Presc Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:16 Immunosuppressants Arthritis Rheumatology Rheumatoid arthritis Psoriatic arthritis Leflunomide Certolizumab pegol Sulfasalazine Hydroxychloroquine Medicine Health Pharmacology
352	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: 2012-12-05 11:59:45 Alcohols Phenols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Clindamycin Codeine Hydromorphone Chemistry Organic chemistry Morphinans
353	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: 2012-10-01 10:25:59 Alcohols Phenols Anti-acne preparations Euphoriants Tramadol Benzoyl peroxide Codeine Hydromorphone Clindamycin Chemistry Organic chemistry Morphinans
354	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: 2013-01-11 15:47:08 Morphinans Alcohols Phenols Euphoriants Anti-acne preparations Tramadol Codeine Benzoyl peroxide Hydrocodone Chemistry Organic chemistry Medicine
355	D. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections IIIA, B and C above, we will ask for you to sign an authorization before using or disclosing an Add to Reading List Source URL: www.whhs.com Language: English - Date: 2009-09-02 15:22:15 Privacy Health Insurance Portability and Accountability Act Ethics Privacy law Internet privacy
356	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2014-08-22 13:13:18 Bristol-Myers Squibb Angiology Vascular endothelial growth factor Paclitaxel Stomach cancer Esophageal cancer Ramucirumab Metastasis Bevacizumab Medicine Chemistry Gastrointestinal cancer
357	STUDENT EMPLOYMENT AUTHORIZATION FORM Hiring Priority Must be Given to Federal & International Work Study Recipients Instructions: This form is required to be completed by the hiring supervisor prior to employing student Add to Reading List Source URL: www.hws.edu Language: English - Date: 2014-03-18 14:14:21 Supervisor I-9 Government Economy of the United States Management Federal Insurance Contributions Act tax Federal assistance in the United States Social Security
358	Niagara Falls, ON Credit Card Payment Authorization Form Please complete all areas below. Incomplete requests will be rejected. This form must be received at least 5 days prior to Check-In or by specified date in Event Add to Reading List Source URL: www.greatwolf.com Language: English - Date: 2014-10-30 15:24:25 Business Financial economics Credit Debits and credits Credit card fraud Debit card Payment systems Credit card Finance
359	Clinical Edit Proposals At each quarterly meeting, the Texas Drug Utilization Review (DUR) Board reviews and makes recommendations regarding clinical prior authorization edit proposals of certain drugs and drug classes t Add to Reading List Source URL: www.hhsc.state.tx.us Language: English - Date: 2014-09-09 11:43:24 Pharmaceutical drug Pharmacology Antimigraine Drugs
360	Adult Safety with Antipsychotic Prescribing (ASAP) Program What is the Adult Safety with Antipsychotic Prescribing (ASAP) program? North Carolina Medicaid has initiated a prior authorization policy, Off Label Antipsycho Add to Reading List Source URL: www.communitycarenc.com Language: English - Date: 2012-03-16 11:34:30 Schizophrenia Pharmacology Antipsychotic Atypical antipsychotic Schizophreniform disorder Typical antipsychotic Schizoaffective disorder Off-label use Psychosis Psychiatry Abnormal psychology Psychopathology

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