Latest Georgia Department Of Community Health prior authorization updates25

• Prior AuthClinical/Medical PolicyEff. 2015-09-01Georgia Medicaid FFS Synagis (palivizumab) prophylaxis — 2015-2016 RSV seasonDefines Georgia Medicaid FFS coverage and prior authorization requirements for palivizumab (Synagis) prophylaxis during the 2015-2016 RSV season for eligible infants and young children, aligned with 2014 AAP/GAAAP guidance.Georgia Department Of Community HealthPediatrics/NeonatologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyEff. 2014-09-01Georgia Fee-For-Service Medicaid Synagis (palivizumab) Policy for RSV Season 2014-2015Defines Georgia Medicaid Fee-For-Service coverage, limits, and prior authorization process for Synagis (palivizumab) prophylaxis for high-risk infants and children during the 2014-2015 RSV season.Georgia Department Of Community HealthPediatrics/NeonatologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAdrenal hyperplasia agents (Crenessity / crinecerfont) prior authorizationPrior authorization criteria and coverage summary for crinecerfont (Crenessity) for Georgia Medicaid fee-for-service members with classic congenital adrenal hyperplasia. Specifies age/weight, diagnostic confirmation, and authorization lengths.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAmyotrophic lateral sclerosis (ALS) agents prior authorizationDefines prior authorization criteria for select ALS medications for Georgia Medicaid Fee-For-Service members, including eligibility, required trial/failure steps, exceptions process, and authorization length.Georgia Department Of Community HealthNeurology/NeurosurgeryAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAndrogenic Agents, Topical (Testosterone) Prior AuthorizationThis policy governs prior authorization requirements for topical androgenic (testosterone) products for Georgia Medicaid Fee-for-Service members, specifying clinical criteria and documentation needed for coverage of preferred and non-preferred topical testosterone formulations.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAngiotensin receptor blockers (ARBs) and ARB combination prior authorizationDefines prior authorization (PA) requirements and approval criteria for ARB products and ARB combination therapies for Georgia Medicaid fee-for-service members.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntiemetic/Antivertigo Agents prior authorizationOutpatient pharmacy prior authorization criteria for antiemetic and antivertigo medications for Georgia Medicaid fee-for-service members; covers which drugs require PA, clinical indications, and special documentation requirements.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntifibrinolytic agents (tranexamic acid) prior authorizationOutpatient pharmacy prior authorization criteria for tranexamic acid (tablet and injection) under Georgia Medicaid Fee-for-Service; includes coverage conditions, exceptions, and administrative guidance for providers. Applies to outpatient pharmacy claims; office/clinic administration must be billed through physician services.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntihyperuricemics prior authorization (PA) for Georgia MedicaidDefines prior authorization criteria, quantity limits, and coverage guidance for antihyperuricemic agents (e.g., allopurinol, colchicine, febuxostat, probenecid, Gloperba) for Georgia Medicaid Fee-for-Service members and participating providers.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntimigraine agents (triptans) prior authorizationDefines prior authorization requirements, quantity limits, and coverage conditions for triptan migraine and cluster headache therapies in the Georgia Medicaid fee-for-service outpatient pharmacy program. Affects prescribers and pharmacists seeking coverage for listed triptan products.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntiplatelet Drugs Prior Authorization (Zontivity / vorapaxar)Defines prior authorization (PA) criteria and administrative details for antiplatelet medications for Georgia Medicaid Fee-for-Service members, including covered agents and PA process instructions for prescribers and pharmacies.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAntiprotozoals Prior Authorization — Georgia Medicaid FFSRules for prior authorization (PA), coverage criteria, preferred and non-preferred antiprotozoal drugs for Georgia Medicaid Fee-for-Service members; affects prescribers and pharmacists submitting PA requests.Georgia Department Of Community HealthInfectious DiseaseAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyAztreonam prior authorization for Georgia Medicaid FFSDefines prior authorization (PA) requirements, coverage settings, and administrative guidance for aztreonam injection (preferred generic and non-preferred brand) under Georgia Medicaid Fee-for-Service. Affects providers prescribing/administrating aztreonam and billing for members in Georgia Medicaid FFS.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyBenign Prostatic Hyperplasia (BPH) Agents Prior AuthorizationDefines prior authorization criteria, covered strengths, and exceptions for BPH medications for Georgia Medicaid Fee-for-Service members and guidance for prescribers and pharmacies.Georgia Department Of Community HealthUrologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyBile Salts and Related Therapies Prior Authorization (Georgia Medicaid Fee-for-Service)Prior authorization requirements and coverage criteria for bile salt therapies and related drugs (e.g., ursodiol, Cholbam, Chenodal, Bylvay, Livmarli, Iqirvo, Livdelzi, Reltone) for Georgia Medicaid fee-for-service members and prescribers.Georgia Department Of Community HealthGastroenterologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyBladder relaxant (antimuscarinic and beta-3 agonist) prior authorizationDefines prior authorization requirements, preferred vs non-preferred products, age/weight-specific approvals, and quantity/exception processes for bladder relaxant medications for Georgia Medicaid Fee-for-Service members.Georgia Department Of Community HealthUrologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyCalcium Channel Blockers — Prior Authorization CriteriaDefines prior authorization (PA) coverage criteria for dihydropyridine and non-dihydropyridine calcium channel blocker medications for Georgia Medicaid Fee-for-Service members, including special formulations and exception processes.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyCamzyos (mavacamten) prior authorization for obstructive hypertrophic cardiomyopathyDefines prior authorization criteria, duration, and administrative processes for Camzyos (mavacamten) for Georgia Medicaid Fee-for-Service members with obstructive hypertrophic cardiomyopathy. Applies to prescribers, pharmacies, and members seeking coverage under Georgia Medicaid FFS.Georgia Department Of Community HealthCardiologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyCephalosporins and Related Antibiotics Prior Authorization SummarySummarizes prior authorization (PA) requirements for specified amoxicillin/clavulanate and cephalosporin products for Georgia Medicaid Fee-for-Service; affects prescribers and pharmacists requesting non-preferred formulations or specific strengths. Includes guidance on exceptions, PDL access, PA process, and quantity limits.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyComplement inhibitors prior authorization (PA) summaryThis document summarizes prior authorization criteria for complement inhibitor medications for Georgia Medicaid Fee-for-Service members and explains PA process, exceptions, billing notes, and related program links. It affects prescribers and providers seeking coverage for listed complement inhibitor drugs.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyContinuous Glucose Monitors (FreeStyle Libre) — Prior Authorization CriteriaDefines prior authorization coverage criteria and administrative details for select FreeStyle Libre continuous glucose monitor devices for Georgia Medicaid Fee‑For‑Service members.Georgia Department Of Community HealthEndocrinologyAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyCorticotropin prior authorization (Acthar Gel, Cortrophin)Defines prior authorization (PA) requirements and approvable indications for repository corticotropin injections (Acthar Gel and Purified Cortrophin Gel) for Georgia Medicaid fee-for-service members.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyCystine Depleting Agents Prior Authorization (Cystadrops, Cystaran, Cystagon, Procysbi)Defines prior authorization requirements for ocular and systemic cysteamine products for Georgia Medicaid Fee-for-Service members, including preferred status, age limits, G-tube and medical necessity requirements, and 1-year approvals.Georgia Department Of Community HealthPharmacy & Specialty DrugsAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyDaybue (trofinetide) prior authorization for Rett syndromeDefines prior authorization criteria and administrative details for coverage of Daybue (trofinetide) for Georgia Medicaid fee-for-service members, including eligibility, prescriber requirements, and authorization length.Georgia Department Of Community HealthNeurology/NeurosurgeryAll Georgia Department of Community Health updates
• Prior AuthClinical/Medical PolicyDisposable insulin delivery systems (Omnipod DASH and Omnipod 5) — Prior authorization and coverage criteriaPrior authorization and coverage criteria for Omnipod DASH and Omnipod 5 disposable insulin delivery systems for Georgia Medicaid Fee-For-Service members, including age, diagnosis, training, quantity limits, and QLL exceptions.Georgia Department Of Community HealthEndocrinologyAll Georgia Department of Community Health updates