Recent Updates to Pharmacy PA Forms and Criteria
Over the past couple of months, updates and additions have been made to pharmacy forms and criteria. Providers are encouraged to review the recent updates and make sure they are using the most current editions of the documents, which can be found under the Pharmacy Services web page on either the Prior Approval Drugs and Criteria or Drug Request Forms page.
Added
Harvoni Initial and Continuation PA forms – previously only electronic, now offered as a paper form as well
Updated
Fasenra PA form
Emflaza PA Form
Emflaza PA Criteria – (2 years of age and up)
Migraine Calcitonin Gene Therapy PA form
Migraine Calcitonin Gene Therapy PA Criteria
Immunomodulators PA Criteria (adding Siliq and Stelara Infusion)
Crohn’s (Adult) PA Form – (adding Stelara Infusion)
Plaque Psoriasis (Adult) PA Form
BH Clinical PA Criteria (Adult)
BH Clinical PA Criteria (Pediatric)