Pharmacy Services Clinical Coverage Policies
Associated Files
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
Last updated:
First published:
Share this page: