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Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitors (PPIs)

Assigned number Title Release date Language Available to order
F-11078A Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitors (PPIs) Instructions (PDF) 07/01/2026 English No
F-11078 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitors (PPIs) (PDF) 07/01/2026 English No
F-11078 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitors (PPIs) (Word) 07/01/2026 English No

Glossary

 
Last revised September 21, 2026