ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Galafold (migalastat) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2025
တၢ်ဃုသ့ၣ်ညါတၢ်အစၢ
တၢ်ပာ်ဖျါ 2541 - 2550 လၢ 4030 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Gabapentin ER (extended-release) [Horizant, Gralise] - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Erythropoietins - Medicaid
တချုးတၢ်ဟ့ၣ်စိဟ့ၣ်ကမီၤ
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါအီကူာ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Erythropoietins - Commercial
တချုးတၢ်ဟ့ၣ်စိဟ့ၣ်ကမီၤ
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါအီကူာ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Anti-Obesity Non-GLP-1 Agents - Commercial
Formulary Exception, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
QP61-21 Final Determination Letter to be Sent from Cotiviti
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 28, 2021
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
QP60-21 New Form for Long-Term Acute Care, Inpatient Rehabilitation and Skilled Nursing Facility Admissions and Continued Stay Requests
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 28, 2021
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
BCBSMN-PharmProgPolicyNotif-Effective-090121.pdf
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
QP55-21 MHCP Pharmacy Benefit Exclusion for RybrevantTM
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 14, 2021