Pharmacy Services Clinical Coverage Policies

Associated Files

9B.pdf

9B, Hemophilia Specialty Pharmacy Program

PDF308.74 KB

9D.pdf

9D, Off Label Antipsychotic Safety Monitoring in Beneficiaries Through Age 17

PDF314.6 KB

9E.pdf

9E, Off Label Antipsychotic Safety Monitoring in Beneficiaries 18 and Older

PDF300.96 KB

Details

Clinical Coverage Criteria and Prior Approval request forms
Preferred Drug List (PDL)

  • 9, Outpatient Pharmacy Program
  • 9A, Over-The-Counter Products
  • 9B, Hemophilia Specialty Pharmacy Program
  • 9D, Off Label Antipsychotic Safety Monitoring in Beneficiaries Through Age 17
  • 9E, Off Label Antipsychotic Safety Monitoring in Beneficiaries 18 and Older
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