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Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable

Assigned number Title Release date Language Available to order
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable (PDF) 07/01/2020 English No
F-02668A Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable Instructions (PDF) 07/01/2020 English No
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable (Word) 07/01/2020 English No

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Last revised September 13, 2026