ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 3501 - 3510 လၢ 3562 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Pulmonary Arterial Hypertension - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Resmetirom - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Oral Inhalers - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Growth Hormone - Commercial
Prior Authorization
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Otezla (apremilast) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Oral NSAID (Nonsteroidal Anti-Inflammatory Drugs) - Commercial
Step Therapy
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Elagolix/Relugolix - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Gabapentin ER (extended-release) [Horizant, Gralise] - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Dry Eye Disease - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026