Prior Authorization / Preferred Drug List (PA/PDL) for Hypoglycemics, Insulin – Long-Acting

Assigned Number	Title	Version Date	Publication Type	Other Location	Language
F-01749	Effective for Use On or After July 1, 2016: Prior Authorization / Preferred Drug List (PA/PDL) for Hypoglycemics, Insulin – Long-Acting	July 1, 2016	Word	None	English
F-01749	Effective for Use On or After July 1, 2016: Prior Authorization / Preferred Drug List (PA/PDL) for Hypoglycemics, Insulin – Long-Acting	July 1, 2016	PDF	None	English
F-01749	Effective for Use On or After July 1, 2016: Completion Instructions	July 1, 2016	PDF	None	English

Last Revised: August 1, 2019