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Prior authorization
Results: 1240

#	Item
951	PRIOR AUTHORIZATION POLICY Gilenya™ (fingolimod capsules Novartis) To Initiate a Coverage Review, Call[removed] Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-01-29 12:46:53 Cytokines Medicine Immunosuppressants Autoimmune diseases Treatment of multiple sclerosis Glatiramer acetate Interferon beta-1a Fingolimod Natalizumab Immunology Immune system Multiple sclerosis
952	PRIOR AUTHORIZATION POLICY Mekinist™ (trametinib tablets – GlaxoSmithKline) To Initiate a Coverage Review, Call[removed]OVERVIEW Mekinist is a kinase inhibitor indicated for the treatment of patients with unre Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-01-29 12:46:55 Organofluorides Sulfonamides Vemurafenib Chemistry Oncology BRAF Protein kinase inhibitor Metastasis Uveal melanoma Medicine Melanoma Organochlorides
953	PRIOR AUTHORIZATION POLICY Incivek™ (telaprevir film-coated tablets Vertex) To Initiate a Coverage Review, Call[removed] Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-09-02 09:27:17 Biology Health Hepatology Pyrazines Telaprevir Boceprevir Hepatitis Hepatitis C virus Hepatitis C Medicine Protease inhibitors Antivirals
954	PRIOR AUTHORIZATION POLICY Tafinlar® (dabrafenib capsules GlaxoSmithKline) To Initiate a Coverage Review, Call[removed] Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-01-29 12:47:05 Organofluorides Sulfonamides Vemurafenib BRAF Protein kinase inhibitor Cancer Metastasis Medicine Melanoma Organochlorides
955	PRIOR AUTHORIZATION POLICY Omega-3 Fatty Acid Products omega-3-acid ethyl esters capsules (generic) Lovaza® (omega-3-acid ethyl esters capsules – GlaxoSmithKline) Vascepa® (icosapent ethyl capsules – Amarin) To Ini Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-06-02 10:50:50 Medicine Nutrition Treatment of bipolar disorder Fibrates Organochlorides Fenofibrate Omega-3 fatty acid Lovaza Hypertriglyceridemia Chemistry Organic chemistry Fatty acids
956	FORM # FRX024 Prior Authorization Request Form for Hepatitis B Vaccine Member Information Provider Information Patient Name ____________________________ Provider Name _____________________________ Add to Reading List Source URL: www.mainecarepdl.org Language: English - Date: 2012-04-02 14:07:58 Biology Viruses Vaccines Hepatitis B Health Medicine Hepatitis
957	MAINE CENTER FOR DISEASE CONTROL & PREVENTION WIC NUTRITION PROGRAM Medical Documentation for WIC Medical Formula or Medical Food/MaineCare Prior Authorization Form for Medical Formula or Medical Food Healthcare Provider Add to Reading List Source URL: www.mainecarepdl.org Language: English - Date: 2012-03-19 13:50:17 Milk Human development United States Department of Agriculture Federal assistance in the United States Breast milk WIC Infant formula Enfamil Breastfeeding Food and drink Infant feeding Nutrition
958	Dear MDwise Select Health Network Provider: MDwise Select Health Network will be changing prior authorization vendors for Hoosier Healthwise and Healthy Indiana Plan effective[removed]This change will enable MDwise Sele Add to Reading List Source URL: www.mdwise.org Language: English - Date: 2014-02-26 16:55:09
959	PRIOR AUTHORIZATION POLICY POLICY: Zelboraf® (vemurafenib tablet Genentech/Daiichi Sankyo) Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-01-06 13:47:23 Organofluorides Sulfonamides Vemurafenib BRAF Protein kinase inhibitor Daiichi Sankyo Cancer Genentech Metastasis Medicine Melanoma Organochlorides
960	Process for Placing a Drug on Prior Authorization Drug Utilization Review (DUR) Board •The DUR board must approve all prior authorization (PA) criteria for drugs placed on PA •Approval by the DUR board is the first Add to Reading List Source URL: www.kdheks.gov - Date: 2013-02-27 08:55:00

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