ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Arikayce® (amikacin liposome inhalation) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 341 - 350 လၢ 3159 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Arikayce® (amikacin liposome inhalation) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Antifungals - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Pseudobulbar Affect (PBA) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Pseudobulbar Affect (PBA) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Zeposia® (ozanimod) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Xhance® (fluticasone propionate) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
DPP-4 (dipeptidyl peptidase-4) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Coverage Exception - Commercial - NetResults Key Rx & Focus Rx
Coverage Exception
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Sodium-glucose Co-transporter (SGLT) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025