ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
ATTR Amyloidosis - Commercial
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
တၢ်ဃုသ့ၣ်ညါတၢ်အစၢ
တၢ်ပာ်ဖျါ 4171 - 4180 လၢ 4303 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Gabapentin ER (extended-release) - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Vijoice (alpelisib) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Kerendia - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Glucose Test Strips and Meters - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Calcitonin Gene-Related Peptide (CGRP) - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Triptans - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Pulmonary Arterial Hypertension - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Leucovorin - Medicaid
Prior Authorization, Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Harliku - Medicaid
Quantity Limit
တၢ်ရဲၣ်တၢ်ကျဲၤစးထီၣ်မူ၀ဲအမုၢ်နံၤမုၢ်သီ- လါယူၤ 01, 2026