Utilization Management
Prior Authorization and Step Therapy Policies for Medicaid
| Pulmonary Arterial Hypertension - Orenitram PA Policy | Policy |
| Pulmonary Arterial Hypertension - Phosphodiesterase Type 5 Inhibitors PA Policy | Policy |
| Pulmonary Arterial Hypertension - Uptravi PA Policy | Policy |
| Pulmonary Arterial Hypertension - Winrevair PA | Policy |
| Repository Corticotropin - Acthar Gel PA Policy | Policy |
| Repository Corticotropin - Cortrophin Gel PA | Policy |
| Sickle Cell Disease - Endari PA Policy | Policy |
| Sickle Cell Disease - Oxbryta PA Policy | Policy |
| Sohonos PA | Policy |
| Somatostatin Analogs - Lanreotide Products PA | Policy |
| Somatostatin Analogs - Octreotide Immediate-Release Products PA Policy | Policy |
| Somatostatin Analogs - Octreotide Long-Acting Products PA | Policy |
| Somatostatin Analogs - Somatuline Depot PA Policy | Policy |
| Somavert PA Policy | Policy |
| Tasimelteon Products PA | Policy |
| Testosterone (Oral, Topical, and Nasal) Products PA Policy | Policy |
| Thrombocytopenia - Doptelet PA Policy | Policy |
| Thrombocytopenia - Eltrombopag Products PA | Policy |
| Thrombocytopenia - Eltromboppag Products PA | Policy |
| Thrombocytopenia - Wayrilz PA | Policy |
| Tolvaptan Products - Tolvaptan (Samsca) PA Policy | Policy |
| Topical Acyclovir Products PA Policy | Policy |
| Topical Diclofenac Sodium 3% Gel PA | Policy |
| Topical Retinoids - Aklief PA Policy | Policy |
| Topical Retinoids - Tazarotene Products PA Policy | Policy |
| Vesicular Monoamine Transporter Type 2 Inhibitors - Tetrabenazine PA Policy | Policy |
| Wakefulness-Promoting Agents - Armodafinil, Modafinil PA with Step Therapy Policy | Policy |
| Wakefulness-Promoting Agents - Sunosi PA Policy with Step Therapy | Policy |
| Weight Loss - Glucagon-Like Peptide-1 Agonists PA | Policy |