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Prior authorization
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#	Item
741 $Osteoporosis / Bisphosphonates / Traumatology / Dual-energy X-ray absorptiometry / Ibandronic acid / Bone fracture / Bolus / Hip fracture / Denosumab / Medicine / Health / Osteopathies$	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.ahca.myflorida.com Language: English - Date: 2012-06-25 14:31:43 Osteoporosis Bisphosphonates Traumatology Dual-energy X-ray absorptiometry Ibandronic acid Bone fracture Bolus Hip fracture Denosumab Medicine Health Osteopathies
742	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: 2012-06-25 14:32:40 Morphinans Alcohols Euphoriants Phenols Drug rehabilitation Buprenorphine Methadone Opioid dependence Duragesic Chemistry Organic chemistry Medicine
743	Attachment B Prior Authorization Form Respiratory Syncytial Virus/Synagis™ (Palivizumab) Passport Health Plan Fax to: ([removed] Add to Reading List Source URL: www.passporthealthplan.com Language: English - Date: 2011-11-18 10:26:54 Human respiratory syncytial virus Respiratory diseases MedImmune Medical diagnosis AstraZeneca Medicine Palivizumab
744	Microsoft Word - Prior Authorization Request Form for Strattera.doc Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-04-02 14:35:45 Organic chemistry Psychiatry Childhood psychiatric disorders Attention Educational psychology Attention deficit hyperactivity disorder Atomoxetine Methylphenidate Address Attention-deficit hyperactivity disorder Nootropics Chemistry
745	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us - Date: 2012-06-25 14:39:12
746	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.ahca.myflorida.com Language: English - Date: 2014-05-14 15:34:38 Chemistry Gastroenterology Medicine Anorectics Exenatide Bristol-Myers Squibb Metformin Diabetes management Sulfonylurea Anti-diabetic drugs Eli Lilly and Company Diabetes
747	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us - Date: 2013-08-13 16:31:31
748	Division: Pharmacy Services Subject: AUTO PA (Automated Prior Authorization) Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2012-09-10 11:55:22 AIDS HIV Antiretroviral drug Medicaid Zidovudine AIDS/LifeCycle HIV/AIDS Health Medicine
749	Microsoft Word - Prior Authorization Request Form for Rebetron.doc Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-04-02 14:10:57 Interferon Ribavirin Medicine Hepatitis C virus Peginterferon alfa-2a Virus Hepatitis C and HIV co-infection Antivirals Pharmacology Biology
750	MEDICAL SERVICES DIVISION Date added[removed]Effective[removed]PRIOR AUTHORIZATION FORM COMPLETION GUIDE Add to Reading List Source URL: www.nd.gov Language: English - Date: 2013-03-11 09:49:07 Medicaid Medical prescription Health Medicine Federal assistance in the United States Healthcare reform in the United States Presidency of Lyndon B. Johnson

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