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Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants

Assigned Number Title Release Date File Type Language Available to Order
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants 01/01/2017 PDF English No
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants 01/01/2017 Word English No
F-01672A Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants, Instructions 01/01/2022 PDF English No

Glossary

 
Last revised September 26, 2024