Recent Changes to Drug Forms and Criteria as of July 1, 2019

There have been some recent changes to pharmacy prior approval (PA) forms and criteria. Please take note of the updates listed below and make sure you are using the most current version to prevent denials. 

Updated

  • Monoclonal Antibodies Criteria
  • Dupixent for Atopic Dermatitis PA Request Form
  • Nucala Form
  • Antifungal Agents - Vusion Criteria
  • Topical Anti-Inflamatory Criteria
  • Topical Anti-Inflammatory Form
  • Topical Local Anesthetics
  • Austedo for Movement Disorders
  • Ingrezza for Movement Disorders
  • Xenazine and tetrabenazine for Movement Disorders

Removed

  • Removed Qualaquin criteria (PA no longer required)
  • Removed Qualaquin form (PA no longer required)
  • Topical Anti-Inflammatories - removed Dupixent (added it to Monoclonal Antibodies)
  • Temporary Eucrisa PA form