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Pharmacy Prior Authorization Program

 

Request for Prior Authorization for a Non-Preferred Drug
Introductory Letter	Prior Authorization (PA) Cheat Sheet
Enhanced PA Program	Final Criteria Sheet
Forms
PA01 - Modafinil	PA10 - Agents Treating Pulmonary Hypertension
PA02 - CNS Stimulants	PA11 - Fuzeon
PA04 - Weight Loss	PA12 - Xolair
PA05 - Follicle Stimulation	PA16 - Chronic Idiopathic Constipation
PA06 - Growth Hormone	PA17 - Qualaquin
PA09 - Botox