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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