Prior Authorization Drug Attachment for Modafinil and Nuvigil®

Assigned Number Titlesort descending Version Date Publication Type Other Location Language
F-00079 Effective for Use Before 01/01/2018: Completion Instructions January 13, 2017
PDF
English
F-00079 Effective for Use Before 01/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil® January 13, 2017
Word
English
F-00079 Effective for Use Before 01/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil® (PDF, 603 KB) January 13, 2017
PDF
English
F-00079 Effective for Use On and After 01/01/2018: Instructions January 1, 2018
PDF
English
F-00079 Effective for Use On and After 01/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil® January 1, 2018
Word
English
F-00079 Effective for Use On and After 01/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil® January 1, 2018
PDF
English
Last Revised: December 15, 2017