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Serostim
DRUGS REQUIRING PRIOR AUTHORIZATION in the MEDICAL BENEFIT Page 1
SPECIALTY MEDICATIONS Available Through Accredo Health Group, Inc., Medco’S Specialty Pharmacy Call Toll-Free (800) 803-2523, 8:00 A.M
Somatropin Adult Mcp004d
Earnings Presentation
Exactus Drug List by Disease State
VNSNY CHOICE Total Prior Authorization Requirements Effective: 01/01/2021
Growth Hormones Is Recommended in Those Who Meet the Following Criteria
Growth Hormone
Pre-Certification Requirements for Procedures, Programs & Drugs
Health Net Pharmaceutical Services (HNPS) at (800) 977-8226
Growth Hormone [Somatropin]
MSM PDL Document 010109
Formulary Drug List
Pharmacy Medical Necessity Guidelines: Growth Hormone
Life Science
GE Specialty Drug List
Medications Limited to a 30-Day Supply This List Is Subject to Change at Any Time
FEP 5 Tier Rx Drug Formulary (607) Standard Option
Top View
NYS Medicaid Fee-For-Service Preferred Drug List PREFERRED DRUG LIST – TABLE of CONTENTS I
Growth Hormone Agents (Revised June 8, 2021)
MID DE 7-01-2020 VISC-3 New Code.Xlsx
Long-Lasting Growth Hormone Regulated by the Ubiquitin-Proteasome System
Drugs That Can Affect Blood Glucose Levels GENERIC NAME (BRAND NAME)
Mandatory Specialty Drug List
Drug Name Tier Level Notes Drug Name Tier Level
Specialty Drug List
FEP 5 Tier Managed Rx Drug Formulary (807) Basic Option
Prior Authorization — Premium
2020 Prescription Drug List
Department of Human Services IOWA Medicaid Program Final PDL PDL Effective Date October 1, 2019 (Two Drug Columns)
Prior Authorization and Step Therapy Document
Drugs That Can Affect Blood Glucose Levels Generic Name (Brand Name)
Specialty Drug List
Aetna Specialty Pharmacy Most Frequently Prescribed Medications
Somatropin (Norditropin, Genotropin)
Growth Hormone NOTICE