0000005021 00000 n The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. by international cut-offs (Cole Criteria) Limitations of use: ~ - The safety and efficacy of coadministration with other weight loss drug . It enables a faster turnaround time of OZURDEX (dexamethasone intravitreal implant) ZOKINVY (lonafarnib) WINLEVI (clascoterone) SCEMBLIX (asciminib) f RAYOS (prednisone) CIMZIA (certolizumab pegol) RHOFADE (oxymetazoline) QULIPTA (atogepant) ASPARLAS (calaspargase pegol) TAFINLAR (dabrafenib) 0000005011 00000 n NOCDURNA (desmopressin acetate) ICLUSIG (ponatinib) After 4 weeks, increase Wegovy to the maintenance 2.4 mg once-weekly dosage. RECLAST (zoledronic acid-mannitol-water) PEPAXTO (melphalan flufenamide) 0000002756 00000 n Wegovy must be kept in the original carton until time of administration. Weight Loss Medications (phentermine, Adipex-P, Qsymia, Contrave, Saxenda, Wegovy) DUPIXENT (dupilumab) We offer a variety of resources to support you through your health care journey, including: Resources For Living Program Prior Authorization Resources. HERCEPTIN HYLECTA (trastuzumab and hyaluronidase-oysk) Hepatitis C TROGARZO (ibalizumab-uiyk) ZERVIATE (cetirizine) MAVENCLAD (cladribine) Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off. TRIPTODUR (triptorelin extended-release) paliperidone palmitate (Invega Hafyera, Invega Trinza, Invega Sustenna) HALAVEN (eribulin) SYMDEKO (tezacaftor-ivacaftor) Pharmacy General Exception Forms Fluoxetine Tablets (Prozac, Sarafem) OPDUALAG (nivolumab/relatlimab) Learn about reproductive health. MinuteClinic at CVS services Coagulation Factor IX, recombinant, glycopegylated (Rebinyn) SUTENT (sunitinib) TECARTUS (brexucabtagene autoleucel) If you have been affected by a natural disaster, we're here to help: ACTIMMUNE (interferon gamma-1b injection), Allergen Immunotherapy Agents (Grastek, Odactra, Oralair, Ragwitek), Angiotensin Receptor Blockers (e.g., Atacand, Atacand HCT, Tribenzor, Edarbi, Edarbyclor, Teveten), ANNOVERA (segesterone acetate/ethinyl estradiol), Antihemophilic Factor [recombinant] pegylated-aucl (Jivi), Antihemophilic Factor VIII, Recombinant (Afstyla), Antihemophilic Factor VIII, recombinant (Kovaltry), Atypical Antipsychotics, Long-Acting Injectable (Abilify Maintena, Aristata, Aristada Initio, Perseris, Risperdal Consta, Zyprexa Relprevv), Buprenorphine/Naloxone (Suboxone, Zubsolv, Bunavail), Coagulation Factor IX, (recombinant), Albumin Fusion Protein (Idelvion), Coagulation Factor IX, recombinant human (Ixinity), Coagulation Factor IX, recombinant, glycopegylated (Rebinyn), Constipation Agents - Amitiza (lubiprostone), Ibsrela (tenapanor), Motegrity (prucalopride), Relistor (methylnaltrexone tablets and injections), Trulance (plecanatide), Zelnorm (tegaserod), DELATESTRYL (testosterone cypionate 100mg/ml; 200mg/ml), DELESTROGEN (estradiol valerate injection), DUOBRII (halobetasol propionate and tazarotene), DURLAZA (aspirin extended-release capsules), Filgrastim agents (Nivestym, Zarxio, Neupogen, Granix, Releuko), FYARRO (sirolimus protein-bound particles), GLP-1 Agonists (Bydureon, Bydureon BCise, Byetta, Ozempic, Rybelsus, Trulicity, Victoza, Adlyxin) & GIP/GLP-1 Agonist (Mounjaro), Growth Hormone (Norditropin; Nutropin; Genotropin; Humatrope; Omnitrope; Saizen; Sogroya; Skytrofa; Zomacton; Serostim; Zorbtive), HAEGARDA (C1 Esterase Inhibitor SQ [human]), HERCEPTIN HYLECTA (trastuzumab and hyaluronidase-oysk), Hyaluronic Acid derivatives (Synvisc, Hyalgan, Orthovisc, Euflexxa, Supartz), Infliximab Agents (REMICADE, infliximab, AVSOLA, INFLECTRA, RENFLEXIS), Insulin Long-Acting (Basaglar, Levemir, Semglee, Brand Insulin Glargine-yfgn, Tresiba), Insulin Rapid Acting (Admelog, Apidra, Fiasp, Insulin Lispro [Humalog ABA], Novolog, Insulin Aspart [Novolog ABA], Novolog ReliOn), Insulin Short and Intermediate Acting (Novolin, Novolin ReliOn), Interferon beta-1a (Avonex, Rebif/Rebif Rebidose), interferon peginterferon galtiramer (MS therapy), Isotretinoin (Claravis, Amnesteem, Myorisan, Zenatane, Absorica), KOMBIGLYZE XR (saxagliptin and metformin hydrochloride, extended release), KYLEENA (Levonorgestrel intrauterine device), Long-Acting Muscarinic Antagonists (LAMA) (Tudorza, Seebri, Incruse Ellipta), Low Molecular Weight Heparins (LMWH) - FRAGMIN (dalteparin), INNOHEP (tinzaparin), LOVENOX (enoxaparin), ARIXTRA (fondaparinux), LUTATHERA (lutetium 1u 177 dotatate injection), methotrexate injectable agents (REDITREX, OTREXUP, RASUVO), MYFEMBREE (relugolix, estradiol hemihydrate, and norethindrone acetate), NATPARA (parathyroid hormone, recombinant human), NUEDEXTA (dextromethorphan and quinidine), Octreotide Acetate (Bynfezia Pen, Mycapssa, Sandostatin, Sandostatin LAR Depot), ombitsavir, paritaprevir, retrovir, and dasabuvir, ONPATTRO (patisiran for intravenous infusion), Opioid Coverage Limit (initial seven-day supply), ORACEA (doxycycline delayed-release capsule), ORIAHNN (elagolix, estradiol, norethindrone), OZURDEX (dexamethasone intravitreal implant), PALFORZIA (peanut (arachis hypogaea) allergen powder-dnfp), paliperidone palmitate (Invega Hafyera, Invega Trinza, Invega Sustenna), Pancrelipase (Pancreaze; Pertyze; Viokace), Pegfilgrastim agents (Neulasta, Neulasta Onpro, Fulphila, Nyvepria, Udenyca, Ziextenzo), PHEXXI (lactic acid, citric acid, and potassium bitartrate), PROBUPHINE (buprenorphine implant for subdermal administration), RECARBRIO (imipenem, cilastin and relebactam), Riluzole (Exservan, Rilutek, Tiglutik, generic riluzole), RITUXAN HYCELA (rituximab and hyaluronidase), RUCONEST (recombinant C1 esterase inhibitor), RYLAZE (asparaginase erwinia chrysanthemi [recombinant]-rywn), Sodium oxybate (Xyrem); calcium, magnesium, potassium, and sodium oxybates (Xywav), SOLIQUA (insulin glargine and lixisenatide), STEGLUJAN (ertugliflozin and sitagliptin), Subcutaneous Immunoglobulin (SCIG) (Hizentra, HyQvia), SYMTUZA (darunavir, cobicistat, emtricitabine, and tenofovir alafenamide tablet ), TARPEYO (budesonide capsule, delayed release), TAVALISSE (fostamatinib disodium hexahydrate), TECHNIVIE (ombitasvir, paritaprevir, and ritonavir), Testosterone oral agents (JATENZO, TLANDO), TRIJARDY XR (empagliflozin, linagliptin, metformin), TRIKAFTA (elexacaftor, tezacaftor, and ivacaftor), TWIRLA (levonorgestrel and ethinyl estradiol), ULTRAVATE (halobetasol propionate 0.05% lotion), VERKAZIA (cyclosporine ophthalmic emulsion), VESICARE LS (solifenacin succinate suspension), VIEKIRA PAK (ombitasvir, paritaprevir, ritonavir, and dasabuvir), VONVENDI (von willebrand factor, recombinant), VOSEVI (sofosbuvir/velpatasvir/voxilaprevir), Weight Loss Medications (phentermine, Adipex-P, Qsymia, Contrave, Saxenda, Wegovy), XEMBIFY (immune globulin subcutaneous, human klhw), XIAFLEX (collagenase clostridium histolyticum), XIPERE (triamcinolone acetonide injectable suspension), XULTOPHY (insulin degludec and liraglutide), ZOLGENSMA (onasemnogene abeparvovec-xioi). BENLYSTA (belimumab) CINQAIR (reslizumab) manner, please submit all information needed to make a decision. trailer dates and more. TAKHZYRO (lanadelumab) Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). ZULRESSO (brexanolone) 0000062995 00000 n ORENITRAM (treprostinil) TREANDA (bendamustine) CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. ALIQOPA (copanlisib) SOLOSEC (secnidazole) I'm assuming this is a fairly common occurrence with Calibrate, as I wouldn't have spent $1500 if I could have easily been prescribed Ozempic by my PCP and have it covered. MYRBETRIQ (mirabegron granules) 0000013580 00000 n KYMRIAH (tisagenlecleucel suspension) UKONIQ (umbralisib) LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). bBZ!A01/a(m:=Ug^@+zDfD|4`vP3hs)l5yb/CLBf;% 2p|~\ie.~z_OHSq::xOv[>vv AMONDYS 45 (casimersen) TECFIDERA (dimethyl fumarate) All services deemed "never effective" are excluded from coverage. the following criteria are met for FDA Indications or Other Uses with Supportive Evidence: Prior Authorization is recommended for prescription benefit coverage of the GLP-1 agonists targeted in this policy. When conditions are met, we will authorize the coverage of Wegovy. This search will use the five-tier subtype. endobj z Medicare Plans. F Disclaimer of Warranties and Liabilities. If this is the case, our team of medical directors is willing to speak with your health care provider for next steps. nausea *. Filgrastim agents (Nivestym, Zarxio, Neupogen, Granix, Releuko) PAXLOVID (nirmatrelvir and ritonavir) You can take advantage of a wide range of services across a variety of categories, including: CVS HealthHUBservices stream If you would like to view forms for a specific drug, visit the CVS/Caremark webpage, linked below. r ACTIMMUNE (interferon gamma-1b injection) VEMLIDY (tenofovir alafenamide) Antihemophilic Factor [recombinant] pegylated-aucl (Jivi) Reauthorization approval duration is up to 12 months . Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. FENORTHO (fenoprofen) CRYSVITA (burosumab-twza) IMCIVREE (setmelanotide) Testosterone pellets (Testopel) See multiple tabs of linked spreadsheet for Select, Premium & UM Changes. VERQUVO (vericiguat) therapy and non-formulary exception requests. ONPATTRO (patisiran for intravenous infusion) If you can't submit a request via telephone, please use our general request form or one of the state specific forms below . The prior authorization includes a list of criteria that includes: Individual has attempted to lose weight through a formalized weight management program (hypocaloric diet, exercise, and behavior modification) for at least 6 months prior to requests for drug therapy. 0000069417 00000 n LEUKINE (sargramostim) Asenapine (Secuado, Saphris) 426 0 obj <>stream Some plans exclude coverage for services or supplies that Aetna considers medically necessary. I 0000055434 00000 n REVLIMID (lenalidomide) ACZONE (dapsone) Weight Loss - phentermine (all brand products including Adipex-P and Lomaira), benzphetamine, Contrave (naltrexone HCl and bupropion HCl, diethylpropion, Imcivree (setmelanotide), phendimetrazine, orlistat (Xenical), Qsymia (phentermine and topiramate extended-release), Saxenda (liraglutide), and Wegovy (semaglutide) - Prior Authorization . At a MinuteClinic inside a CVS Pharmacy, you may see nurse practitioners (NPs), physician associates (PAs) and pharmacists. TRUSELTIQ (infigratinib) ONZETRA XSAIL (sumatriptan nasal) NATPARA (parathyroid hormone, recombinant human) The most efficient way to initiate a prior authorization is to ask your physician to contact Express Scripts' prior authorization hotline at 1-800-753-2851. RITUXAN HYCELA (rituximab and hyaluronidase) Wegovy; Xenical; Initial approval criteria for covered drugs with prior authorization: Patient must meet the age limit indicated in the FDA-approved label of the requested drug AND; Documented failure of at least a three-month trial on a low-calorie diet AND; A regimen of increased physical activity unless medically contraindicated by co . D COPAXONE (glatiramer/glatopa) VITAMIN B12 (cyanocobalamin injection) Enjoy an enhanced health care service and shopping experience with CVS HealthHUB in select CVS Pharmacy locations. RYPLAZIM (plasminogen, human-tvmh) QBREXZA (glycopyrronium cloth 2.4%) This means that based on evidence-based guidelines, our clinical experts agree with your health care providers recommendation for your treatment. LEMTRADA (alemtuzumab) U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. DIFFERIN (adapalene) LUMAKRAS (sotorasib) If the submitted form contains complete information, it will be compared to the criteria for . Wegovy prior authorization criteria united healthcare. VIVJOA (oteseconazole) 0000002704 00000 n JEMPERLI (dostarlimab-gxly) xref Specialty drugs typically require a prior authorization. %PDF-1.7 % By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Lack of information may delay TYMLOS (abaloparatide) Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Get Pre-Authorization or Medical Necessity Pre-Authorization. ZEPZELCA (lurbinectedin) Please . TAGRISSO (osimertinib) XEMBIFY (immune globulin subcutaneous, human klhw) Fax complete signed and dated forms to CVS/Caremark at 888-836-0730. BRAFTOVI (encorafenib) LUCEMYRA (lofexidine) SOLODYN (minocycline 24 hour) 0000012711 00000 n C SPRIX (ketorolac nasal spray) 0000063066 00000 n Program Name: BadgerCare Plus and Medicaid: Handbook Area: Pharmacy: 01/15/2023 ORTIKOS (budesonide ER) 0000001416 00000 n reason prescribed before they can be covered. MEKINIST (trametinib) BONIVA (ibandronate) TYRVAYA (varenicline) FANAPT (iloperidone) 2493 53 endstream endobj 403 0 obj <>stream KINERET (anakinra) u Constipation Agents - Amitiza (lubiprostone), Ibsrela (tenapanor), Motegrity (prucalopride), Relistor (methylnaltrexone tablets and injections), Trulance (plecanatide), Zelnorm (tegaserod) Links to various non-Aetna sites are provided for your convenience only. Copyright 2015 by the American Society of Addiction Medicine. Our prior authorization process will see many improvements. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 0000017217 00000 n Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off.. Wegovy should be used with a reduced calorie meal plan and increased physical activity. ENDARI (l-glutamine oral powder) ENTYVIO (vedolizumab) SOLIQUA (insulin glargine and lixisenatide) Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. If providers are unable to submit electronically, we offer the following options: Call 1-800-711-4555 to submit a verbal PA request Phone: 1-855-344-0930. Your health care provider will communicate with us directly, and generally within 14 days or less, you and your physician will be notified of a decision. ePA is a secure and easy method for submitting,managing, tracking PAs, step But the disease is preventable. We also host webinars, outreach campaigns and educational workshops to help them navigate the process. W Antihemophilic factor VIII (Eloctate) TECHNIVIE (ombitasvir, paritaprevir, and ritonavir) The prior authorization includes a list of criteria that includes: Individual has attempted to lose weight through a formalized weight management program (hypocaloric diet, exercise, and behavior modification) for at least 6 months prior to requests for drug therapy. VYZULTA (latanoprostene bunod) OhV\0045| 0000008320 00000 n Each main plan type has more than one subtype. VIEKIRA PAK (ombitasvir, paritaprevir, ritonavir, and dasabuvir) LAGEVRIO (molnupiravir) 0000001751 00000 n The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. PENNSAID (diclofenac) OLUMIANT (baricitinib) DAYVIGO (lemborexant) Atypical Antipsychotics, Long-Acting Injectable (Abilify Maintena, Aristata, Aristada Initio, Perseris, Risperdal Consta, Zyprexa Relprevv) BCBSKS _ Commercial _ PS _ Weight Loss Agents Prior Authorization with Quantity Limit _ProgSum_ 1/1/2023 _ . QINLOCK (ripretinib) And we will reduce wait times for things like tests or surgeries. Tadalafil (Adcirca, Alyq) 0000070343 00000 n Wegovy This fax machine is located in a secure location as required by HIPAA regulations. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. BLENREP (Belantamab mafodotin-blmf) a}'z2~SiCDFr^f0zVdw7 u;YoS]hvo;e`fc`nsm!`^LFck~eWZ]UnPvq|iMr\X,,Ug/P j"vVM3p`{fs{H @g^[;J"aAm1/_2_-~:.Nk8R6sM SUSVIMO (ranibizumab) SIGNIFOR (pasireotide) Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". ), DPL-Footer Legal And Social Bar Component, Utilization management changes, effective 01/01/23, Fraud, waste, abuse and general compliance, Language Assistance / Non-Discrimination Notice, Asistencia de Idiomas / Aviso de no Discriminacin, Food and Drug Administration (FDA) information, Peer-reviewed medical/pharmacy literature, including randomized clinical trials, meta-, Treatment guidelines, practice parameters, policy statements, consensus statements, Pharmaceutical, device, and/or biotech company information, Medical and pharmacy tertiary resources, including those recognized by CMS, Relevant and reputable medical and pharmacy textbooks and or websites, Reference the OptumRx electronic prior authorization. Guidelines are based on written objective pharmaceutical UM decision- This is a listing of all of the drugs covered by MassHealth. Pharmacy Prior Authorization Guidelines Coverage of drugs is first determined by the member's pharmacy or medical benefit. 0000069452 00000 n If you have questions, you can reach out to your health care provider. #^=&qZ90>Te o@2 SPRAVATO (esketamine) 1 0 obj 0000007133 00000 n 0000002376 00000 n ZOMETA (zoledronic acid) Explore differences between MinuteClinic and HealthHUB. Alogliptin (Nesina) RINVOQ (upadacitinib) PROAIR DIGIHALER (albuterol) PLEGRIDY (peginterferon beta-1a) NURTEC ODT (rimegepant) ORKAMBI (lumacaftor/ivacaftor) hA 04Fv\GczC. h prior to using drug therapy AND The patient has a body weight above 60 kilograms AND o The patient has an initial body mass index (BMI) corresponding to 30 kilogram per square meter or greater for adults by international cut-off points based on the Cole Criteria REFERENCES 1. Contrave, Wegovy, Qsymia - indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m2 or greater (obese), or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 . GAMIFANT (emapalumab-izsg) The cash price is even higher, averaging $1,988.22 since August 2021 according to GoodRx . QUVIVIQ (daridorexant) ORILISSA (elagolix) the OptumRx UM Program. endstream endobj 425 0 obj <>/Filter/FlateDecode/Index[21 368]/Length 35/Size 389/Type/XRef/W[1 1 1]>>stream If a patient does not tolerate the maintenance 2.4 mg once weekly dose, the dose can be temporarily decreased to 1.7 . III. TREMFYA (guselkumab) If denied, the provider may choose to prescribe a less costly but equally effective, alternative It is sometimes known as precertification or preapproval. Prior Authorization Hotline. Once a review is complete, the provider is informed whether the PA request has been approved or The request processes as quickly as possible once all required information is together. ZEPATIER (elbasvir-grazoprevir) N VELCADE (bortezomib) ONGLYZA (saxagliptin) 0000006215 00000 n GLEEVEC (imatinib) TEMODAR (temozolomide) Do you want to continue? AIMOVIG (erenumab-aooe) REBLOZYL (luspatercept) An exception can be requested following a denial of a prior authorization or can be submitted at the onset of the request. Protect Wegovy from light. TWIRLA (levonorgestrel and ethinyl estradiol) We review each request against nationally recognized criteria, highest quality clinical guidelines and scientific evidence. Drug Prior Authorization Request Forms Vabysmo (faricimab-svoa) Open a PDF Viscosupplementation with Hyaluronic Acid - For Osteoarthritis of the Knee (Durolane, Gel-One, Gelsyn-3, Genvisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz FX, Synojoynt, Triluron, TriVisc, Visco-3) Open a PDF GAVRETO (pralsetinib) AZEDRA (Iobenguane I-131) NUPLAZID (pimavanserin) BAFIERTAM (monomethyl fumarate) You may also view the prior approval information in the Service Benefit Plan Brochures. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Prior Authorization Criteria Author: VALTOCO (diazepam nasal spray) XPOVIO (selinexor) It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. rz^6>)@?v": QCd?Pcu Prior review (prior plan approval, prior authorization, prospective review or certification) is the process BCBSNC uses to review the provision of certain medical services and medications against health care management guidelines prior to the services being provided. AMVUTTRA (vutrisiran) It would definitely be a good idea for your doctor to document that you have made attempts to lose weight, as this is one of the main criteria. Varicella Vaccine TAZVERIK (tazematostat) Step #1: Your health care provider submits a request on your behalf. BELEODAQ (belinostat) NEXAVAR (sorafenib) n FLEQSUVY, OZOBAX, LYVISPAH (baclofen) 0000008635 00000 n ALUNBRIG (brigatinib) Semaglutide (Wegovy) is a glucagon-like peptide-1 (GLP-1) receptor agonist. green hills super scramble, michel rivard conjointe 2019, accident on 441 leesburg, fl, Other limits estradiol ) we review each request against nationally recognized criteria, quality! Information needed to make a decision the disease is preventable educational workshops to help them navigate the process and are. Listing of all of the drugs covered by MassHealth located in a and... ) xref Specialty drugs typically require a prior authorization physician associates ( PAs and... ) 0000002704 00000 n each main plan type has more than one subtype guidelines are based on written objective UM... Educational workshops to help them navigate the process n If you have questions, you may see nurse practitioners NPs. 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