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Medicaid Medication Policies



Name
Type
State
Adcetris Medical & Pharmacy PA Medicaid
Alimta Medical & Pharmacy PA Medicaid
Aloxi Medical & Pharmacy PA Medicaid
Antipsychotics for Children Less than 18 Pharmacy PA Medicaid
Avastin & Bevacizumab Biosimilars Medical & Pharmacy PA Medicaid
Avonex Pharmacy PA Medicaid
Benlysta Medical & Pharmacy PA Medicaid
Botox Medical & Pharmacy PA Medicaid
Brineura Medical & Pharmacy PA Medicaid
Buprenorphine SL Pharmacy PA Medicaid
Buprenorphine SL Pharmacy PA Medicaid
Cerdelga Pharmacy PA Medicaid
Cerezyme Medical & Pharmacy PA Medicaid
Cidofovir Medical & Pharmacy PA Medicaid
Cimzia Pharmacy PA Medicaid
Copaxone Pharmacy PA Medicaid
Cough and Cold Medications for Children less than 4 Pharmacy PA Medicaid
Crysvita Pharmacy PA Medicaid
Cystic Fibrosis Biologic Response Modifiers Pharmacy PA Medicaid
Daraprim Pharmacy PA Medicaid
Depen Pharmacy PA Medicaid
Duzallo Pharmacy PA Medicaid
Emflaza Pharmacy PA Medicaid
Enbrel Pharmacy PA Medicaid
Enbrel Pharmacy PA Medicaid
Entresto Pharmacy PA Medicaid
Erbitux Medical & Pharmacy PA Medicaid
Erythropoiesis Stimulating Agents Pharmacy PA Medicaid
Esbriet Pharmacy PA Medicaid
Eucrisa Pharmacy PA Medicaid
Exelon Pharmacy PA Medicaid
Exondys-51 Medical & Pharmacy PA Medicaid
Eylea Medical & Pharmacy PA Medicaid
Ezetimibe Pharmacy PA Medicaid
Fabrazyme Pharmacy PA Medicaid
Faslodex Medical & Pharmacy PA Medicaid
Feraheme Medical & Pharmacy PA Medicaid
First Generation Antipsychotics Pharmacy PA Medicaid
Freestyle Libre Pharmacy PA Medicaid
Gilenya Pharmacy PA Medicaid
Gleevec Pharmacy PA Medicaid
Granulocyte Colony Stimulating Factors (GCS-Fs) Medical & Pharmacy PA Medicaid
Growth Hormones Pharmacy PA Medicaid
H.P. Acthar Gel Pharmacy PA Medicaid
Hemophilia / Blood Factor Products Pharmacy PA Medicaid
Hemophilia and Blood Factor Products Pharmacy PA Medicaid
Hepatitis B Pharmacy PA Medicaid
Hepatitis C Medications Pharmacy PA Medicaid
Hepatitis C Medications Pharmacy PA Medicaid
Hepatitis C Treatment Pharmacy PA Medicaid
Herceptin Medical & Pharmacy PA Medicaid
Hereditary Angioedema (HAE) Management Pharmacy PA Medicaid
Hereditary Angioedema (HAE) Agents Pharmacy PA Medicaid
Hereditary Angioedema Acute Treatment Pharmacy PA Medicaid
Hereditary Angioedema Prophylaxis Pharmacy PA Medicaid
Humira Pharmacy PA Medicaid
Humira Pharmacy PA Medicaid
Idiopathic Pulmonary Fibrosis(IPF) Medications Pharmacy PA Medicaid
Injectafer Medical & Pharmacy PA Medicaid
Interleukin-5 Inhibitors Medical & Pharmacy PA Medicaid
Intravenous and Subcutaneous Immune Globulin (IVIG & SCIG) Medical & Pharmacy PA Medicaid
Intravenous (IV) Iron Medical & Pharmacy PA Medicaid
Keytruda Medical & Pharmacy PA Medicaid
Kyprolis Medical & Pharmacy PA Medicaid
Krystexxa Medical & Pharmacy PA Medicaid
Latuda Pharmacy PA Medicaid
Lidocaine Patch Pharmacy PA Medicaid
Lucentis Medical & Pharmacy PA Medicaid
Lumizyme Medical & Pharmacy PA Medicaid
Lupron Medical & Pharmacy PA Medicaid
Luxturna Medical & Pharmacy PA Medicaid
Lyrica Pharmacy PA Medicaid
Lyrica Prior Authorization Form PA Medicaid
Makena Pharmacy PA Medicaid
Makena Pharmacy PA Medicaid
Modafinil Pharmacy PA Medicaid
Mozobil Medical & Pharmacy PA Medicaid
Multiple Sclerosis (MS) Medications Medical & Pharmacy PA Medicaid
Non-TNF Biologics Pharmacy PA Medicaid
Norditropin Pharmacy PA Medicaid
Nplate Medical & Pharmacy PA Medicaid
Ocrevus Medical & Pharmacy PA Medicaid
Oncology Medications Medical & Pharmacy PA Medicaid
Opdivo Medical & Pharmacy PA Medicaid
Opioid Analgesics Pharmacy PA Medicaid
Opioid Analgesics Pharmacy PA Medicaid
Oral Oncology Medications Pharmacy PA Medicaid
Ozempic Pharmacy PA Medicaid
PCSK9 Inhibitor Initial Authorization Pharmacy PA Medicaid
PCSK9 Inhibitor Reauthorization Pharmacy PA Medicaid
PCSK9 Inhibitors Pharmacy PA Medicaid
PCSK9 Inhibitors Pharmacy PA Medicaid
Peg-Intron Pharmacy PA Medicaid
Pegasys Pharmacy PA Medicaid
Perjeta Medical & Pharmacy PA Medicaid
Photofrin Medical & Pharmacy PA Medicaid
Portrazza Medical & Pharmacy PA Medicaid
Prialt Medical & Pharmacy PA Medicaid
Pulmonary Arterial Hypertension(PAH) Agents Pharmacy PA Medicaid
Pulmozyme Pharmacy PA Medicaid
Pulmozyme Pharmacy PA Medicaid
Radicava Pharmacy PA Medicaid
Remicade & Infliximab Biosimilars Medical & Pharmacy PA Medicaid
Restasis Pharmacy PA Medicaid
Restasis Pharmacy PA Medicaid
Rituxan Medical & Pharmacy PA Medicaid
Second Generation Antipsychotics for Children less than 18 Pharmacy PA Medicaid
Simponi/Simponi Aria Pharmacy PA Medicaid
Soliris Medical & Pharmacy PA Medicaid
Somatuline Depot Medical & Pharmacy PA Medicaid
Spinraza Medical & Pharmacy PA Medicaid
Sublingual Immunotherapy Medications Pharmacy PA Medicaid
Supprelin LA & Vantas Medical & Pharmacy PA Medicaid
Synagis Pharmacy PA Medicaid
Synagis Pharmacy PA Medicaid
Synvisc and Synvisc One Pharmacy PA Medicaid
Synvisc and Synvisc-One Pharmacy PA Medicaid
Tacrolimus Ointment Pharmacy PA Medicaid
Tecfidera Pharmacy PA Medicaid
Thrombopoietin (TPO) Receptor Agonists Medical & Pharmacy PA Medicaid
Topical Retinoid Pharmacy PA Medicaid
Trogarzo Pharmacy PA Medicaid
Trogarzo Pharmacy PA Medicaid
Tysabri Medical & Pharmacy PA Medicaid
Velcade Medical & Pharmacy PA Medicaid
Victoza Pharmacy PA Medicaid
Vimizim Medical & Pharmacy PA Medicaid
Voltaren Gel Pharmacy PA Medicaid
Voltaren Gel Pharmacy PA Medicaid
Xeljanz and Xeljanz XR Pharmacy PA Medicaid
Xgeva and Prolia Pharmacy PA Medicaid
Xifaxan Pharmacy PA Medicaid
Xolair Medical & Pharmacy PA Medicaid
Yervoy Medical & Pharmacy PA Medicaid
Zyvox Pharmacy PA Medicaid