Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil

Assigned Number Titlesort descending Version Date Publication Type Other Location Language
F-00079 Completion Instructions December 1, 2013
PDF
English
F-00079 Completion Instructions January 13, 2017
PDF
English
F-00079 Completion Instructions (for use before January 1, 2015) October 1, 2014
PDF
English
F-00079 Completion Instructions (PDF, 47 KB) December 1, 2012
PDF
English
F-00079 Completion Instructions (PDF, KB) January 1, 2015
PDF
English
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil January 1, 2019
Word
English
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil January 1, 2019
PDF
English
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil Instructions January 1, 2019
PDF
English
F-00079 Prior Authorization / Drug Attachment for Modafinil and Nuvigil (PDF, 1434 KB) December 1, 2012
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil December 1, 2013
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil July 1, 2018
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil July 1, 2018
Word
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil January 1, 2018
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil (PDF, 1234 KB) October 1, 2014
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions July 1, 2018
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions January 1, 2018
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® January 13, 2017
Word
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® (PDF, 603 KB) January 13, 2017
PDF
English
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® (PDF, KB) January 1, 2015
PDF
English
Last Revised: August 1, 2019