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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 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

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 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

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 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

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 Diabetic Supplies, Insulin Pens or Cartridges
 Diastat
 Divalproex - Updated 5/28/09
 Doribax
 Dorzoloamide
 Dorzoloamide Timolol
 Doxycycline Oral Suspension

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 Elaprase
 Emsam - Updated 5/30/08
 Epoetin
 Estradiol/Norethindrone Acetate - Updated 7/11/08
 Etoposide
 Extina

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 Fentanyl
 Fibric Acid Derivatives - Updated 5/28/09
 Finacea Plus Kit
 Finasteride
 Flector 
 Flo-Pred Oral Suspension
 Forteo
 Fusilev

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 Galantamine - Updated 5/28/09
 Growth Hormones - Updated 1/14/09

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 HIV Medications - Updated 1/20/09
 Hyaluronidase
 Hylira - Updated 8/28/08

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 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

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 Kerol
 Kristalose

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 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

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 Macrolides-Ketolides - Updated 9/12/08
 Magnacet and Perloxx
 Marinol
 Megace ES
 Merrem
 Metformin Products
 Methadone
 Minocin PAC
 Mircera
 Miscellaneous Analgesics
 Moxatag
 Mozobil

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 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

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 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

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 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

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 Quinolones - Updated 5/28/09

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 Rapaflo
 Ranexa - Updated 1/14/09
 Regranex - Updated 2/1/08
  Requip XL 
 Retisert

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  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

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 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

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 Uloric
 Ultravate - Updated 7/11/08
 Uramaxin Urea Kerafoam
 Urinary Tract Antispasmotics - Updated 9/12/08

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 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

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 Xenical - Updated 12/8/08
 Xenazine
 Xifaxan - Updated 4/24/08
 Xolair
 Xolegel - Updated 1/14/09
 Xopenex HFA
 Xyrem - Updated 7/11/08

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 Zacare 
 Zelapar
 Zelnorm
 Zolinza
 Zyvox - Updated 10/31/08

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