Prior Authorization Process and Criteria
Helpful hints for the Georgia Medicaid pharmacy prior authorization process can be found at this link.
Medication Prior Authorization (PA) Fact Sheet - Updated 2/14/08
The Georgia Department of Community Health is in the process of providing conditions for coverage for medications requiring prior authorization in the Georgia Medicaid program. To view the conditions for coverage, please select the drug or drug category from the list below.
Drug/Drug Category by Alphabetical listing
5-HT3 Receptor Antagonists - Updated 9/29/09
Ace Inhibitors - Updated 12/8/08
ACE Inhibitors plus CCB - Updated 2/5/08
Ace Inhibitor/Diuretic Combinations - Updated 5/27/08
Acetazolamide
Actiq
Adoxa Doryx and Doxycycline Monohydrate - Updated 1/14/09
Afinitor
Altabax - Updated 2/1/08
Amevive
Amitiza
Anabolic Steroids
Angiotensin Receptor Blockers
Angiotensin Receptor Blockers And Diuretics
Anti-Acne - Updated 1/14/09
Antihyperkinesis Agents - Updated 4/16/09
Aranesp
Atypical Antipsychotics Prior Authorization Request Form
Atypical Antipsychotics - Updated 7/28/09
Azasite - Updated 1/10/08
Azor
Balsalazide
Benzodiazepines - Updated 5/27/08
Beta Adrenergics - Updated 4/24/08
Beta Blockers - Updated 5/28/09
BiDil - Updated 05/29/08
Bile Acid Sequestrants - Updated 05/29/08
Bone Ossification Suppression - Updated 4/24/08
Botox/Myobloc - Updated 11/27/07
Brovana and Perforomist
Byetta
Calcium Channel Blockers – Dihydropyridines - Updated 12/8/08
Calcium Channel Blockers – Nondihydropyridines - Updated 2/1/08
Calcipotriene
Celebrex
Cephalosporins - 3rd Generation - Updated 12/8/08
Cesamet
Ciclopirox Gel
Cimzia - Updated 4/16/09
Co-Enzyme_Q10 - Updated 5/28/09
Colony Stimulating Factors - Updated 5/30/08
Combigan
Combunox
COPD Anticholinergics - Updated 12/8/08
Crinone
Cubicin
Cytovene
Diabetic Supplies, Insulin Pens or Cartridges
Diastat
Divalproex - Updated 5/28/09
Doribax
Dorzoloamide
Dorzoloamide Timolol
Doxycycline Oral Suspension
Elaprase
Emsam - Updated 5/30/08
Epoetin
Estradiol/Norethindrone Acetate - Updated 7/11/08
Etoposide
Extina
Fentanyl
Fibric Acid Derivatives - Updated 5/28/09
Finacea Plus Kit
Finasteride
Flector
Flo-Pred Oral Suspension
Forteo
Fusilev
Galantamine - Updated 5/28/09
Growth Hormones - Updated 1/14/09
HIV Medications - Updated 1/20/09
Hyaluronidase
Hylira - Updated 8/28/08
Immune Globulin - Updated 5/28/09
Immunomodulators - Updated 5/30/08
Increlex and Iplex
Inhaled Steroids - Updated 1/14/09
Inspra
Insulins
Interferons
Invanz
Isotretinoin - Updated 2/1/08
Lactulose
Lamisil/Penlac/Sporanox - Updated 1/14/09
Leukotriene Receptor Antagonist: Singulair, Accolate And Zyflo - Updated 1/14/09
Lido-Hydro Gel
Long Acting Narcotics
Low Sedating Antihistamines And Combination Products - Updated 1/14/09
Lovaza
Macrolides-Ketolides - Updated 9/12/08
Magnacet and Perloxx
Marinol
Megace ES
Merrem
Metformin Products
Methadone
Minocin PAC
Mircera
Miscellaneous Analgesics
Moxatag
Mozobil
NSAID and COX II - Updated 6/3/09
Nasal Steroids - Updated 9/29/09
Neotic
Neupro
New Generation AntiDepressants - Updated 5/28/09
Niacor
Noxafil
Nucort
Nutridox
Ocella
Opana and Opana ER - Updated 6/17/08
Ophthalmic Antihistamines - Updated 5/28/09
Opthalmic Beta Blockers
Ophthalmic Quinolones - Updated 5/28/09
Oracea
OrapredODT
Orencia - Updated 6/17/08
Ovace
Pamine_FQ - Updated 8/28/08
Panretin
Parcopa
Patanase - Updated 7/11/08
Pegasys - Updated 4/24/08
Phosphate Binders - Updated 5/28/09
Prandimet
Prenatal Vitamins - Updated 3/10/09
Primaxin
Prostaglandin Agonists - Updated 4/24/08
Proton Pump Inhibitors - Updated 5/28/09
Proton Pump Inhibitors PA Request Form
Quinolones - Updated 5/28/09
Rapaflo
Ranexa - Updated 1/14/09
Regranex - Updated 2/1/08
Requip XL
Retisert
Salkera - Updated 7/11/08
Second Generation Anticonvulsants - Updated 4/16/09
Serostim - Updated 1/14/09
Serotonin Receptor Agonists (Triptans) - Updated 5/28/09
Sleep Aids
Sodium Sulfacetamide
Solodyn
Somatuline Depot - Updated 7/11/08
Sprycel - Updated 7/11/08
SSRI - Updated 7/28/09
Statins and Lipid Lowering Agents - Updated 12/8/08
Stavzor
Suboxone and Subutex - Updated 4/24/08
Sutent - Updated 7/11/08
Symlin
Synagis PA Request Form - Updated 9/10/09
Synagis PA Summary - Updated 10/13/09
Taclonex - Updated 7/11/08
Tarceva - Updated 2/1/08
Tasigna - Updated 7/11/08
Tekturna - Updated 5/1/08
Temodar - Updated 7/11/08
Testosterone Injections - Updated 7/11/08
Tindamax - Updated 7/7/08
Tobramycin Dexamethazone - Updated 9/29/09
Topical Corticosteroid - Updated 2/14/09
Topical Estrogens - Updated 7/11/08
Topical Immunomodulators - Updated 7/11/08
Topical Testosterone - Updated 7/11/08
Trelstar
Tysabri - Updated 10/30/08
Tyzeka
Uloric
Ultravate - Updated 7/11/08
Uramaxin Urea Kerafoam
Urinary Tract Antispasmotics - Updated 9/12/08
Vectical
Ventavis - Updated 7/11/08
Vfend - Updated 7/11/08
Vitamin D and ESRD Products - Updated 1/14/09
Vitamin E - Updated 7/11/08
Vivitrol
Voltaren Gel - Updated 10/9/08
Voltaren Ophthalmic Solution - Updated 7/11/08
Vusion - Updated 7/11/08
Xenical - Updated 12/8/08
Xenazine
Xifaxan - Updated 4/24/08
Xolair
Xolegel - Updated 1/14/09
Xopenex HFA
Xyrem - Updated 7/11/08
