Specialty Exceptions Autoimmune ACSF BAL PDPD VF 3246 D P2020a |
Specialty Exceptions Autoimmune ACSF BAL PDPD VF 3246 D P2020a |
Specialty Exceptions Autoimmune ACSF PDPD VF 2718 D P2019a |
Specialty Exceptions Hepatitis B ACSF 3035 D P2019 |
Specialty Exceptions Multiple Sclerosis STD ACSF PDPD P2019a |
Specialty Exceptions Multiple Sclerosis STD ACSF PDPD P2019a |
Specialty Generics First Criteria |
Specialty Quantity Limit 1699 H Zydelig P2019 |
Specialty Quantity Limit Acthar |
Specialty Quantity Limit Afinitor 2223 H P2019 |
Specialty Quantity Limit Alecensa 2436 H P2019 |
Specialty Quantity Limit Arcalyst 1744 H P2019 |
Specialty Quantity Limit Austedo 1725 H P2019 |
Specialty Quantity Limit Ayvakit 3492 H P2020 |
Specialty Quantity Limit Balversa 2968 H P2019 |
Specialty Quantity Limit Berinert 3055 H P2019 |
Specialty Quantity Limit Bosulif 1720 H P2019 |
Specialty Quantity Limit Braftovi P2018 |
Specialty Quantity Limit Brukinsa 3413 H P2019 |
Specialty Quantity Limit Cabometyx 1614 H P2019 |