2023 Draft PA Criteria
Review the Draft PA Criteria for 2023.
Draft PA Criteria January
- Adult Rheumatoid Arthritis Agents January 2023 (PDF)
- Atopic Dermatitis Agents January 2023 (PDF)
- Diabetes Mellitus Type 2 Agents January 2023 (PDF)
- Hemophilia B Gene Therapy January 2023 (PDF)
- Hypercholesterolemia Agents January 2023 (PDF)
- Minimum Requirements January 2023 (PDF)
- Oncology Auxiliary Treatment Agents January 2023 (PDF)
Draft PA Criteria April
- 0 Executive Sign-Off April 2023 (PDF)
- Adult Rheumatoid Arthritis Agents April 2023 (PDF)
- Alzheimer's Disease Agents (previously Aduhelm) April 2023 (PDF)
- Axial Spondyloarthritis (previously Ankylosing Spondylitis) Agents April 2023 (PDF)
- Crohns Disease Agents April 2023 (PDF)
- Diabetes Mellitus Type 2 Agents April 2023 (PDF)
- Enzyme Replacement Therapy April 2023 (PDF)
- Minimum Requirements PA April 2023 (PDF)
- Multiple Sclerosis (MS) Agents April 2023 (PDF)
- Oncology Agents April 2023 (PDF)
- Opioid Use Disorder Agents April 2023 (PDF)
- Psoriatic Arthritis Agents April 2023 (PDF)
- Ulcerative Colitis (UC) Agents April 2023 (PDF)
Draft PA Criteria July
- Adult Rheumatoid Arthritis Agents July 2023 (PDF)
- Advanced Medical Hold Manual Review July 2023 (PDF)
- Alzheimers Disease Agents (previously Aduhelm) July 2023 (PDF)
- Axial Spondyloarthritis Agents July 2023 (PDF)
- Brand Medical Necessity July 2023 (PDF)
- Crohns Disease Agents July 2023 (PDF)
- Diabetes Mellitus Type 2 Agents July 2023 (PDF)
- Duchenne Muscular Dystrophy (DMD) Gene Therapy July 2023 (PDF)
- Enzyme Replacement Therapy July 2023 (PDF)
- Hemophilia A Gene Therapy July 2023 (PDF)
- Hypercholesterolemia Agents July 2023 (PDF)
- Juvenile Idiopathic Arthritis (JIA) Agents July 2023 (PDF)
- Migraine Acute Treatment Agents July 2023 (PDF)
- Migraine Prophylaxis Agents July 2023 (PDF)
- Minimum Requirements July 2023 (PDF)
- Non-preferred PDL July 2023 (PDF)
- Plaque Psoriasis (PsO) Agents July 2023 (PDF)
- Psoriatic Arthritis Agents July 2023 (PDF)
- Ulcerative Colitis (UC) Agents July 2023 (PDF)
- Weight Loss Agents July 2023 (PDF)
Draft PA Criteria October
- ADHD Medications - Safe Use for All Ages October 2023 (PDF)
- Anti-Constipation Agents October 2023 (PDF)
- Antipsychotic Medications - Safe Use for All Ages October 2023 (PDF)
- Minimum Requirements October 2023 (PDF)
- Monoamine Depletor October 2023 (PDF)
- Opioid Products Indicated for Pain Management October 2023 (PDF)
- Synagis October 2023 (PDF)