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Medical management

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Coverage and authorization

Prior authorization services

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Medical injectables

Medical benefit prior authorization form

Medical oncology drugs (effective 1/1/23)
 
Exception to coverage forms
For new FDA -pproved drugs on the market for less than a year that haven't been reviewed or granted approval through the Pharmacy & Therapeutics Committee
  • Pharmacy drug
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Information & forms

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Prior authorization

  • Behavioral health
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  • Automated authorization
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Prior authorization forms

  • Behavioral health
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