Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis

Assigned Number Titlesort descending Version Date Publication Type Other Location Language
F-11304 Effective for use before 01/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis January 1, 2018
Word
English
F-11304 Effective for use before 01/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis January 1, 2018
PDF
English
F-11304 Effective for use before 01/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis Instructions January 1, 2018
PDF
English
F-11304 Effective for use on and after 01/01/2019: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis January 1, 2019
Word
English
F-11304 Effective for use on and after 01/01/2019: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis January 1, 2019
PDF
English
F-11304 Effective for use on and after 01/01/2019: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis Instructions January 1, 2019
PDF
English
Last Revised: December 14, 2018