Pharmacy Services Clinical Coverage Policies

Associated Files

9.pdf

9, Outpatient Pharmacy Program

PDF • 511.1 KB

9A.pdf

9A, Over-The-Counter Products

PDF • 225.56 KB

9B.pdf

9B, Hemophilia Specialty Pharmacy Program

PDF • 233.61 KB

9C.pdf

9C, Mental Health Drug Management Program Administrative Procedures

PDF • 221.21 KB

9D.pdf

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

PDF • 235.68 KB

9E.pdf

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

PDF • 229.7 KB

Details

9, Outpatient Pharmacy Program
Clinical Coverage Criteria and Prior Approval request forms
Preferred Drug List (PDL)
9A, Over-The-Counter Products
9B, Hemophilia Specialty Pharmacy Program
9C, Mental Health Drug Management Program Administrative Procedures
9D, Off Label Antipsychotic Safety Monitoring in Beneficiaries Through Age 17
9E, Off Label Antipsychotic Safety Monitoring in Beneficiaries 18 and Older

First published:

Sep 25, 2015

Last Updated:

Mar 15, 2019

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