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Class-Specific Clinical Criteria
- ADHD Medications - Safe Use for All Ages (PDF)
- Adult Rheumatoid Arthritis Agents (PDF)
- Alpha1-Proteinase Inhibitors (PDF)
- Alzheimers Disease Agents (PDF)
- Anti-Constipation Agents (PDF)
- Antidepressant Medications - Safe Use for All Ages (PDF)
- Anti-Obesity Medications (PDF)
- Antipsychotic Medications - Safe Use for All Ages (PDF)
- Asthma Agents (PDF)
- Atopic Dermatitis Agents (PDF)
- Axial Spondyloarthritis Agents (PDF)
- Benzodiazepine Medications - Safe Use for All Ages (PDF)
- Beta Thalassemia Agents (PDF)
- Botulinum Toxins (PDF)
- Brand Medical Necessity (PDF)
- Carisoprodol Containing Products (PDF)
- Chimeric Antigen Receptor T-Cell (CAR-T) Therapy Agents (PDF)
- Crohns Disease Agents PA Criteria (PDF)
- Diabetes Mellitus Type 2 Agents (PDF)
- Duchenne Muscular Dystrophy (DMD) Agents (PDF)
- Duchenne Muscular Dystrophy (DMD) Gene Therapy (PDF)
- Enzyme Replacement Therapy (PDF)
- Executive Sign-Off (PDF)
- Growth Hormone PA Criteria (PDF)
- Hemophilia A Gene Therapy (PDF)
- High Cost Compounds PA Criteria (PDF)
- Hypercholesterolemia Agents (PDF)
- Intravenous Immune Globulins (IVIG) (PDF)
- Juvenile Idiopathic Arthritis (JIA) Agents (PDF)
- Migraine Acute Treatment Agents (PDF)
- Migraine Prophylaxis Agents (PDF)
- Minimum Requirements Prior Authorization (PDF)
- Monoamine Depletor (VMAT2 Inhibitors) (PDF)
- Multiple Sclerosis Agents (PDF)
- Narcolepsy Agents (PDF)
- Neuromyelitis Optica Spectrum Disorder (NMOSD) Agents (PDF)
- Oncology - Auxiliary Treatment Agents (PDF)
- Oncology Agents PA (PDF)
- Opioid PA Criteria (PDF)
- Opioid Use Disorder (PDF)
- Plaque Psoriasis (PsO) Agents (PDF)
- Psoriatic Arthritis Agents (PDF)
- Spinal Muscular Atrophy (SMA) (PDF)
- Systemic Lupus Erythematosus (SLE) Agents (PDF)
- Thyroid Eye Disease Agents (PDF)
- Topical and Buccal Androgen Hormone Agents (PDF)
- Ulcerative Colitis (UC) Agents (PDF)