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
Acarbose
Ace Inhibitors - Updated 2/1/08
ACE Inhibitors plus CCB - Updated 2/5/08
Ace Inhibitor/Diuretic Combinations - Updated 5/27/08
Actiq
Altabax - Updated 2/1/08
Alimta
Amevive
Amitiza
Amrix
Anabolic Steroids
Angiotensin Receptor Blockers
Angiotensin Receptor Blockers And Diuretics
Anti-Acne
Antihyperkinesis Agents - Updated 11/29/07
Aranesp
Atypical Antipsychotics Prior Authorization Request Form
Atypical Antipsychotics
Azasite - Updated 1/10/08
Azor
Balsalazide
Benzodiazepines - Updated 5/27/08
Beta Adrenergics - Updated 4/24/08
Beta Blockers
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 4/24/08
Calcium Channel Blockers – Nondihydropyridines - Updated 2/1/08
Calcipotriene
Cefuroxime - Updated 05/29/08
Cephalosporins - 3rd Generation - Updated 5/27/08
Cesamet
Cimzia
Co-Enzyme_Q10
Colony Stimulating Factors - Updated 5/30/08
Combigan
Combunox
COPD Anticholinergics
Compounds
Crinone
Cubicin
Diabetic Supplies, Insulin Pens or Cartridges
Diastat
Doribax
Elaprase
Emsam - Updated 5/30/08
Epoetin
Estradiol/Norethindrone Acetate - Updated 7/11/08
Exforge
Extina
Fentanyl
Fibric Acid Derivatives- Updated 4/28/08
Finasteride
Flector
Flo-Pred Oral Suspension
Forteo
Granisetron - Updated 7/11/08
Growth Hormones
HIV Medications - Updated 3/13/08
Hylira - Updated 8/28/08
Immune Globulin - Updated 11/27/07
Immunomodulators - Updated 5/30/08
Increlex and Iplex
Inhaled Steroids
Insulins
Interferons
Isotretinoin - Updated 2/1/08
Ixempra
Januvia and Janumet - Updated 11/27/07
Kristalose
Lactulose
Lamisil/Penlac/Sporanox
Leukotriene Receptor Antagonist: Singulair, Accolate And Zyflo
Long Acting Narcotics
Low Sedating Antihistamines And Combination Products
Lovaza
Macrolides-Ketolides
Magnacet and Perloxx
Marinol
Megace ES
Metformin Products
Methadone
Minocin PAC
Mircera
Monodox and Adoxa - Updated 5/1/08
Moxatag
Mupirocin
Neupro
NSAID and COX II - Updated 5/1/08
Nasal Steroids - Updated 4/24/08
New Generation Antidepressants - Updated 2/1/08
Noxafil
Ocella
Ofloxacin Otic
Opana and Opana ER - Updated 6/17/08
Ophthalmic Antihistamines
Ophthalmic Quinolones
Oracea
OrapredODT
Orencia - Updated 6/17/08
Pamine_FQ - Updated 8/28/08
Panretin
Patanase - Updated 7/11/08
Pegasys - Updated 4/24/08
Phosphate Binders
Prostaglandin Agonists - Updated 4/24/08
Proton Pump Inhibitors - Updated 4/24/08
Proton Pump Inhibitors PA Request Form
Quinolones - Updated 2/1/08
Raptiva - Updated 2/1/08
Ranexa
Regranex - Updated 2/1/08
Relistor
Requip_XL
Retisert
Revatio - Updated 7/11/08
Rituxan - Updated 7/7/08
Salkera - Updated 7/11/08
Second Generation Anticonvulsants
Serostim
Serotonin Receptor Agonists (Triptans)
Sleep Aids
Soliris
Somatuline Depot - Updated 7/11/08
Sprycel - Updated 7/11/08
SSRI
Statins and Lipid Lowering Agents - Updated 5/30/08
Suboxone and Subutex - Updated 4/24/08
Sutent - Updated 7/11/08
Symlin
Synagis
Synagis PA Request Form
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
Topical Corticosteroid - Updated 2/1/08
Topical Estrogens - Updated 7/11/08
Topical Immunomodulators - Updated 7/11/08
Topical Testosterone - Updated 7/11/08
Tovalt ODT
Tysabri - Updated 5/1/08
Tyzeka
Ultravate - Updated 7/11/08
Urinary Tract Antispasmotics
Ventavis - Updated 7/11/08
Vfend - Updated 7/11/08
Vidaza - Updated 7/11/08
Vitamin D and ESRD Products - Updated 5/30/08
Vitamin E - Updated 7/11/08
Vivitrol
Voltaren Gel - Updated 7/11/08
Voltaren Ophthalmic Solution - Updated 7/11/08
Vusion - Updated 7/11/08
Xenical - Updated 7/11/08
Xifaxan - Updated 4/24/08
Xolair
Xolegel
Xopenex HFA
Xyrem - Updated 7/11/08
Zacare
Zaleplon
Zelapar
Zelnorm
Zolinza
Zometa
Zyvox