ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Vowst™ (fecal microbiota spores, live-brpk) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 861 - 870 လၢ 3159 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Rho-Kinase Inhibitor - Commercial
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Urinary Incontinence - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Urinary Incontinence - Commercial
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Camzyos™ (mavacamten) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Camzyos™ (mavacamten) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Tarpeyo™ (budesonide) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Tarpeyo™ (budesonide) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
OTC Covid-19 At Home Test Quantity Limit - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Cholestasis Pruiritis - Medicaid
Prior Authorization
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024