ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Topical NSAID - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 3491 - 3500 လၢ 3562 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Topical Actinic Keratosis, Basal Cell Carcinoma, Genital Wart Agents - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Corticotropin - Commercial
Prior Authorization
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Biologic Immunomodulators - FocusRx (For Pharmacy Benefits Only) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Saxenda Wegovy Zepbound - Commercial
Coverage Exception, Formulary Exception, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Self-Administered Oncology Agents - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Phenylketonuria - Commercial
Prior Authorization
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Sensipar (cinacalcet) - Commercial
Prior Authorization
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Thrombopoietin Receptor Agonists and Tavalisse - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026