List of Drugs Under Review

Medication must meet Package Insert requirements for FDA-approved indication, age, dose, and frequency, as well as the additional requirements outlined.

AMHMR Prior Authorization Criteria (PDF)

Drugs & Prior Authorization Criteria Number

DrugAdditional PA Approval Criteria Number
Adlarity4
Adstiladrin®Package Insert
Airsupra6
Ala-Scalp®1
Altuviio6
Aspruzyo Sprinkle™ 
6
Austedo® XR4
Clemastine syrup4
Cosentyx® UnoReady 2
Cuvrior6
Cyltezo®3
DemserPackage Insert
ElevidysPackage Insert
Enjaymo™ 6
Entadfi6
Fiasp® PumpCart1
Hadlima3
Hulio®3
Hyftor™ gelPackage Insert
Hyrimoz®3
Idacio®3
ImcivreePackage Insert
Inpefa6
Joenja®Package Insert
Lumryz2
Lymepak1
Lyuzeh1
Metformin 625mg tablet1
Miembo1
Ngenla®1
Olpruva6
Omisirge®Package Insert
Pheburane® oral pellets6
Pradaxa® sprinkle4
PyrukyndPackage Insert
QalsodyPackage Insert
Relyvrio oral suspensionPackage Insert
RoctavianPackage Insert
Ryaltris®6
RyplazimPackage Insert
Rystiggo®Package Insert
Skyclarys®Package Insert
Skysona®Package Insert
Sogroya®3
SohonosPackage Insert
Spevigo®Package Insert
Suflave1
Syfovre ™ Package Insert
Trikafta® packetsPackage Insert
TzieldPackage Insert
Valsartan solution4
Vegzelma®6
Veopoz®Package Insert
Veozah6
Verkazia6
Vijoice®Package Insert
Vtama® 6
VyjuvekPackage Insert
Vyvgart® HytruloPackage Insert
Yuflyma3
Zavzpret3
Zoryve™ cream6
Ztalmy® suspension Package Insert


Criteria Descriptions

Criteria Number
Abbreviated Description
1
Falls into existing class/category on Preferred Drug List (PDL), subject to non-preferred PA process.
2
Falls into the existing Step Therapy class PA process.
3
Falls into both PDL and Step Therapy requirements (1 and 2).
4
Chemical drugs available in alternate existing dosage forms to be tried first.
5
Product is a racemic mix, single enantiomer or diastereomer, or isomer of available medication, or prodrug metabolized to available medication or active metabolite of available medication.
6
If the drug does not fall into mentioned categories, the patient must have an inadequate response to two or more medications FDA-approved for the same indication and/or medications that are considered the standard of care for the indication, when such agents exist.