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cream*, ointment (topical) citalopram tablet, solution (oral) donepezil tablet, odt (oral) gentamicin cream, ointment (topical) escitalopram tablet (oral) View PDF

Buckeye Health Plan Preferred Drug List Approved October 09, 2014 Effective October 0 9 , 2014 Preferred Drug List Medication Locator Instructions: View PDF

District of Columbia Department of Health Care Finance Pharmacy Preferred Drug List (PDL) Effective June 17, 2015 Non-preferred medications require prior ... View PDF

Prescription Drug Program (Rev. 3/25/2015)(Eff. 4/01/2015) - 2 - Washington PDL What is the process to obtain drugs on the Washington preferred drug list? View PDF

MARYLAND PREFERRED DRUG LIST Effective Date 7/1/15 Key: cc-Clinical criteria can be found at the link here ql- Quantity limits can be found at the link here View PDF

health and human services commission texas medicaid preferred drug list (pdl) and prior authorization (pa) criteria effective january 22, 2015 View PDF

UHC1004a {Released 2/25/11} i INTRODUCTION UnitedHealthcare is pleased to provide this Preferred Drug List (PDL) to be used when prescribing for patients View PDF

Revised: August 5, 2015 NYS Medicaid Fee-For-Service Preferred Drug List 1 = Preferred as of 6/25/2015 2 = Non-preferred as of 6/25/2015 3 Preferred Drugs Non ... View PDF

Page 3 of 19 SC022492_PRO_LTR_ENG State Approved 06182013 ©WellCare 2013 SC_04_13 52716 Drug Name Therapeutic Class Change PDL Alternative View PDF

Duration of Leave (cont.) (Normal Pregnancy – 6 wks disability only, for those eligible for PDL, but not eligible for FMLA or CFRA) Feb 6|-----| March 19 View PDF

The PDL 1600 Designer Series is a significant breakthrough in style and design excellence - a perfect combination of good looks and feature-rich View PDF

Volume 53 Number 2 Periodontal ligament injection 119 Table II. Results by procedure PDL syringe Conventional syringe Total Percent Percent View PDF

2 3. Does an employee have the right to continued health care benefits while on pregnancy disability leave? Yes, to the same extent and under the same conditions as ... View PDF

1 BRAND PRODUCTS IN UPPER CASE generic names in lower case. If only the generic name is listed as preferred, then the BRAND name of that product is non- View PDF

CALIFORNIA CODE OF REGULATIONS Title 2. Administration ... pregnancy disability leave, although it may require transfer to a less strenuous or hazardous View PDF

health and human services commission texas medicaid preferred drug list (pdl) and prior authorization (pa) criteria effective july 23, 2015 View PDF

Preferred Drug List (PDL) The PDL is a list of commonly prescribed medications within select classes of drugs covered on your formulary. The View PDF

TennCare Preferred Drug List (PDL) Effective August 1, 2015 PA – Prior Authorization required, subject to specific PA criteria, QL – Quantity Limit (PA and NP ... View PDF

Some medications listed on the PDL may not be covered under your specific benefit. Where differences are noted, the benefit plan documents will govern. View PDF

Preferred Drug List Illinois Medicaid July 1, 2015 Changes are highlighted in blue and marked with an asterisk (*) ***For drugs not found on this list, go to the drug ... View PDF

1 January 2015 I. INTRODUCTION 1. This Preferred Drug List (PDL) was updated as of 7/30/2015. It is subject to change without notice. If you choose View PDF

Division of Health Care Financing and Policy Nevada Medicaid Preferred Drug List Effective January 1, 2014 1 Prior Authorization is required for non-preferred agents. View PDF

MISSISSIPPI DIVISION OF MEDICAID UNIVERSAL PREFERRED DRUG LIST (For All Medicaid, MSCAN and CHIP Beneficiaries) 2 This is not an all-inclusive list of available ... View PDF

4 INTRODUCTION We are pleased to provide the 2015 Paramount Advantageâ„¢ Preferred Drug List as a useful reference and informational tool. This is a list of ... View PDF

Page 2 of 3 FL018136_PRO_LTR_ENG State Approve 03072012 ©WellCare 2012 FL_02_12 44181 Drug Name Therapeutic Class Change PDL Alternative View PDF

A user with Administrator access rights to the device has the opportunity to change the PCL5 command used to identify a specific paper tray. A user can do this by ... View PDF

Effective Date: August 1, 2015 Clinical Criteria, Step Therapy, and Quantity Limits for TennCare Preferred Drug List (PDL) | Page 2 View PDF

DELAWARE MEDICAL ASSISTANCE PROGRAM (DMAP) PREFERRED DRUG LIST (PDL) Effective: 07/10/2015; Updated: 07/10/2015 Contents ACNE AGENTS, TOPICAL ... View PDF

health and human services commission texas medicaid preferred drug list (pdl) and prior authorization (pa) criteria effective january 15, 2014 View PDF

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Louisiana Healthcare Connections PROVIDER Preferred Drug List Last Updated November 2012 Effective November 2012 Preferred Drug List Medication Locator Instructions: View PDF

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decided that the following changes will be made to the New York Medicaid Preferred Drug List (PDL), effective February 12, 2014. Please carefully review these changes. View PDF

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Indiana PDL_January 2013 1 Indiana Medicaid Preferred Drug List (PDL) Xerox Clinical Call Center For prior authorization requests and questions about the PDL, please ... View PDF

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Rhode Island Medicaid Fee for Service Preferred Drug List (PDL) Page 2 Macrolides/Ketolides Multiple Sclerosis Narcotic Analgesics, Long Acting View PDF

PDL and CFRA do not Run Concurrently Since CFRA leave rights do not apply to pregnancy and related conditions, PDL and CFRA do not overlap. View PDF

New Hampshire Department of Health and Human Services Preferred Drug List (PDL) NH Department of Health and Human Services 1 Office of Medicaid Business and Po licy View PDF

ADOA PDL – 10-01-2013 SELECT PDL THERAPEUTIC DRUG CATEGORIES Preferred Generic Preferred Brand Non-Preferred Allergy – Nasal Corticosteroids View PDF

Prior Authorization PDL Implementation Schedule Item Nbr Descriptive Therapeutic Class Drugs on PDL Drugs which Require PA Effective Date: January 1, 2014 View PDF

UPDATE HealthEase/Staywell Medicaid Preferred Drug List December 14, 2012 Dear Provider: At the . December 13, 2012. WellCare Pharmacy & Therapeutics Committee ... View PDF

Virginia Medicaid Preferred Drug List With Service Authorization Criteria Effective September 26, 2012 2 Preferred Agents Non-Preferred Agents SA Criteria View PDF

related medical conditions, you are eligible to take a pregnancy disability leave (PDL). ... and sufficient medical certification to support a request for PDL. View PDF

a traditional flip latch or chain. The PDL’s silicone pads provide addi-tional protection for the door. The PDL is UL Classified as a fire door accessory. View PDF

2 Your Prescription Drug List This Prescription Drug List (PDL) outlines the most commonly prescribed medications for certain conditions and organizes them into cost ... View PDF