Provider Documents - Arkansas

Document Type: Basic Document
Extension: doc
Size: 528 KB
Modified: 5/31/23 8:40 PM by Lesley Irons
Created: 4/19/23 8:53 PM by Preetham Karunakaran
Location: Provider Documents
Tags: memorandums
Description: Changes to existing PA Criteria or Edits: desonide 0.05% cream; Revised age ranges and max daily doses for oral 2nd generation (“Atypical”) antipsychotic agents for children;
Clinical edits added through point-of-sale (POS) edit system: Dose edits for oral 1st generation (“Typical”) antipsychotic agents for children; dose edits & manual review for Fanapt®, Latuda®, Saphris® for use in children; perphenazine/amitriptyline tablet use in children; Risperdal® Consta®; Invega® Sustenna®; 1st & 2nd generation long-acting and depot forms of injectable antipsychotic agents; Lexiva® tablets and oral suspension; complete dose-optimization chart for oral antipsychotic agents;

Clinical edits through the Manual Review PA Process: Ridaura® 3 mg capsule; Osphena™ tablet; Signifor® inj.; BiDil® tablet; Diclegis® tablet; Vecamyl™ tablet; Lovaza® capsule, penicillamine; Syprine® capsule; Tafinlar® capsule; Mekinist™ tablet; Glycophos® vial;

AEVCS edits, including Dose-op edits, Cumulative Quantity, Daily Dose edits, Age edits, or Gender edits: Alzheimer’s Disease agents; naltrexone 50 mg tablet; Viramune® tablets and oral suspension and Viramune® XR; Tikosyn® tablets
Categories: Pharmacy

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