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Prior authorization
Results: 1240

#	Item
841	SED/HYP.15 Form # 30110 R: 4.14 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2014-04-21 09:23:36 Nonbenzodiazepines Lactams Benzodiazepines Hypnotics Insomnia Zolpidem Zaleplon Sedative Eszopiclone Chemistry Organic chemistry Organochlorides
842	ANTFG.21 Form # 10120 R:4.14 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2014-04-21 09:09:59 Biology Antifungal medication Itraconazole Terbinafine Nystatin Onychomycosis Clotrimazole Fluconazole Azole Antifungals Microbiology Chemistry
843	CCHP Senior Select Program (HMO SNP[removed]Prior Authorization Drug Requirements Last Updated[removed]FORMULARY DRUG BRAND NAME Add to Reading List Source URL: www.cchphmo.com Language: English - Date: 2013-09-17 18:58:09 Presidency of Lyndon B. Johnson Health Chemistry Medicine Managed care Medicare Part D Health maintenance organization Adapalene Medicaid Pharmaceuticals policy Federal assistance in the United States Healthcare reform in the United States
844	Division: Pharmacy Services Subject: Prior Authorization Criteria – Abilify Maintena Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2013-10-16 14:46:59 Lactams Piperazines Organofluorides Piperidines Aripiprazole Antipsychotic Paliperidone Risperidone Haloperidol Chemistry Organic chemistry Atypical antipsychotics
845	Microsoft Word - Prior Authorization Request Form for Provigil.doc Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-04-02 14:10:14 Sleep Narcolepsy Modafinil Upper airway resistance syndrome Sleep apnea Obstructive sleep apnea Positive airway pressure Shift work sleep disorder Polysomnography Sleep disorders Medicine Health
846	SENS.6 Form # 30115 R:09.08 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-03-19 13:44:54 Secondary hyperparathyroidism Drugs Nephrology Calcium Cinacalcet Phosphate binders Hyperparathyroidism Dialysis Parathyroid hormone Medicine Chemistry Health
847	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: 2014-07-08 08:45:26
848	Division: Pharmacy Services Original Development Date: Original Effective Date: Revision Date: Subject: Prior Authorization Criteria Add to Reading List Source URL: www.fdhc.state.fl.us - Date: 2012-06-25 14:43:53
849	SUB.R.1 Form # [removed]R:04.14 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2014-04-21 09:52:08 Drug rehabilitation Organic chemistry Buprenorphine Euphoriants Phenols Medical record Chemistry Alcohols Morphinans
850	Microsoft Word - Prior Authorization Request Form for Regranex.doc Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-04-02 14:34:10 Dressing Ulcer Address Fax Medicine Technology Debridement

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