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52![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 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](https://www.pdfsearch.io/img/7b2bc0d3c996be2d3704812df817109f.jpg) | Add to Reading ListSource URL: www.dhhr.wv.govLanguage: English - Date: 2014-06-13 08:24:46
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53![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 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](https://www.pdfsearch.io/img/e2c7e2e78c2bd70f8a30ec51548b8ba1.jpg) | Add to Reading ListSource URL: www.dhhr.wv.govLanguage: English - Date: 2014-09-30 10:26:58
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54![Microsoft Word - WV PDL eff[removed]09_2009 3_FINAL Microsoft Word - WV PDL eff[removed]09_2009 3_FINAL](https://www.pdfsearch.io/img/f371212e48f997af66645988632034a1.jpg) | Add to Reading ListSource URL: www.dhhr.wv.govLanguage: English - Date: 2010-12-03 12:25:59
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55![Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and](https://www.pdfsearch.io/img/17dbff6f25c5e627c1a685512687a118.jpg) | Add to Reading ListSource URL: dvha.vermont.govLanguage: English - Date: 2014-06-26 16:09:19
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56![STEP THERAPY POLICY Topical Acne – Cleansers Step Therapy Program (Integrated) To Initiate a Coverage Review, Call[removed]DRUGS AFFECTED: Note: This is not an all-inclusive list. Benzoyl peroxide containing pro STEP THERAPY POLICY Topical Acne – Cleansers Step Therapy Program (Integrated) To Initiate a Coverage Review, Call[removed]DRUGS AFFECTED: Note: This is not an all-inclusive list. Benzoyl peroxide containing pro](https://www.pdfsearch.io/img/09fa47fca3e5467671af85badcc963e3.jpg) | Add to Reading ListSource URL: statehealthplan.state.nc.usLanguage: English - Date: 2014-07-31 14:20:35
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57![STEP THERAPY POLICY Topical Acne - Kits Step Therapy Program (Integrated) To Initiate a Coverage Review, Call[removed]DRUGS AFFECTED: Note: This is not an all-inclusive list (all available strengths) • STEP THERAPY POLICY Topical Acne - Kits Step Therapy Program (Integrated) To Initiate a Coverage Review, Call[removed]DRUGS AFFECTED: Note: This is not an all-inclusive list (all available strengths) •](https://www.pdfsearch.io/img/22b0eceea956a09a8bf21caf34a54984.jpg) | Add to Reading ListSource URL: statehealthplan.state.nc.usLanguage: English - Date: 2014-07-31 14:20:37
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58![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 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](https://www.pdfsearch.io/img/34d8bd22c58d856194a3670d0057414b.jpg) | Add to Reading ListSource URL: dvha.vermont.govLanguage: English - Date: 2013-05-21 20:28:19
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59![Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and](https://www.pdfsearch.io/img/f0f44b2f0b5f35379dfef32cb3fbff28.jpg) | Add to Reading ListSource URL: dvha.vermont.govLanguage: English - Date: 2013-10-16 08:28:32
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60![Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and Department of Vermont Health Access Pharmacy Benefit Management Program VERMONT PREFERRED DRUG LIST and](https://www.pdfsearch.io/img/882a2dd93ca6312de50886e0ee108725.jpg) | Add to Reading ListSource URL: dvha.vermont.govLanguage: English - Date: 2013-05-21 21:10:49
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