ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Oral NSAID (Nonsteroidal Anti-Inflammatory Drugs) - Commercial
Step Therapy
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 01, 2025
တၢ်ဃုသ့ၣ်ညါတၢ်အစၢ
တၢ်ပာ်ဖျါ 3811 - 3820 လၢ 4180 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Oral Anticoagulant - Commercial
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Multiple Sclerosis Agents - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါမ့ၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Multiple Sclerosis Agents - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါမ့ၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Metformin ER - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါမ့ၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Hepatitis C Direct Acting Antivirals - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Glucose Test Strips and Meters - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Glucagon-like Peptide-1 (GLP-1) Agonists - Medicaid
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 15, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
DPP-4 Inhibitors and Combinations - Medicaid
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယူၤလံ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 01, 2025