ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Quantity Limit - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2024
တၢ်ဃုသ့ၣ်ညါတၢ်အစၢ
တၢ်ပာ်ဖျါ 1831 - 1840 လၢ 3686 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Quantity Limit - Commercial
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Cholestasis Pruiritis - Medicaid
တချုးတၢ်ဟ့ၣ်စိဟ့ၣ်ကမီၤ
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Cholestasis Pruiritis - Commercial
တချုးတၢ်ဟ့ၣ်စိဟ့ၣ်ကမီၤ
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Carbaglu® (carglumic acid) - Commercial
တချုးတၢ်ဟ့ၣ်စိဟ့ၣ်ကမီၤ
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါဒံၣ်စဲဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Hepatitis C Direct Acting Antivirals - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2024
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Glucose Test Strips and Meters - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Sodium-glucose Co-transporter (SGLT) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Sodium-glucose Co-transporter (SGLT) Inhibitor and Combinations - Medicaid
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Proton Pump Inhibitors (PPIs) - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအ့ဖြ့ၣ် 01, 2025