ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Interleukin-13 (IL-13) Antagonist - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါမာ်ရှး 01, 2026
တၢ်ဃုသ့ၣ်ညါတၢ်အစၢ
တၢ်ပာ်ဖျါ 3861 - 3870 လၢ 4226 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Cibinqo (abrocitinib) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါမာ်ရှး 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Cibinqo (abrocitinib) - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါမာ်ရှး 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Tarpeyo - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Ryplazim (plasminogen,human-tvmh) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါအီးကထိဘၢၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Tarpeyo - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါနိၣ်၀့ဘၢၣ် 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Oral Anticoagulant - Commercial
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Hepatitis C Direct Acting Antivirals - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါမာ်ရှး 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Glucose Test Strips and Meters - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2025
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Coverage Exception - NetResults (Key Rx and Focus Rx)
Coverage Exception
တၢ်ရဲၣ်တၢ်ကျၢၤစးထီၣ်မူ၀ဲ အမုၢ်နံၤမုၢ်သီ- လါယနူၤအါရံၤ 01, 2026