Prior Authorization Process and Criteria
Prior Authorization (PA) Request Process Guide - Updated October 20, 2011The Georgia Department of Community Health establishes the guidelines for drugs requiring a Prior Authorization (PA) in the Georgia Medicaid Fee-for-Service/PeachCare for Kids® Outpatient Pharmacy Program. To view the summary of guidelines for coverage, please select the drug or drug category from the list below.
Drug/Drug Category by Alphabetical listing (A-M | N - Z)
- ACE Inhibitors- Updated 11/9/11
- ACE Inhibitors plus CCB - Updated 10/4/11
- ACE Inhibitor/Diuretic Combinations - Updated 11/9/11
- Adrenaclick and Twinject - Updated 8/16/11
- Afinitor - Updated 9/02/11
- Agents for BPH - Updated 11/9/11
- Aliskiren and Combinations - Updated 8/23/11
- Aloquin Gel - Updated 12/22/10
- Alpha -1 Proteinase Inhibitors - Updated 12/8/11
- Altabax - Updated 12/22/10
- Amevive - Updated 12/22/10
- Amitiza - Updated 12/22/10
- Amoxicillin Clavulanate - Updated 11/9/11
- Ampyra - Updated 12/22/10
- Anabolic Steroids/Androgens - Updated 8/17/11
- Angiotensin Receptor Blockers - Updated 9/2/11
- Angiotensin Receptor Blockers And Diuretics - Updated 9/2/11
- Antabuse- Updated 11/9/11
- Antidementia Drugs-Updated 10/6/11
- Antiemetics - Updated 8/16/11
- Antifungals - Updated 1/4/12
- Antihyperkinesis Agents - Updated 8/16/11
- Antimalarials - Updated 1/4/12
- Antiplatelet Drugs - Updated 10/4/11
- Apraclonidine - Updated 2/14/11
- Arcalyst Ilaris - Updated 12/22/10
- Atypical Antipsychotics Prior Authorization Request Form - Updated 01/24/12
- Atypical Antipsychotics - Updated 01/24/12
- Augmentin XR - Updated 2/14/11
- Azasite - Updated 12/22/10
- Azor - Updated 12/22/10
- Aztreonam - Updated 11/9/11
- Balsalazide - Updated 3/7/11
- Benzodiazepines - Updated 12/22/10
- Benzoyl Peroxide - Updated 12/22/10
- Beta Agents Short Acting Inhalers - Updated 8/23/11
- Beta Adrenergic Nebulizer Agents - Updated 12/22/10
- Beta Blockers - Updated 12/22/10
- BiDil - Updated 12/22/10
- Bile Acid Sequestrants - Updated 12/22/10
- Bone Ossification Suppression - Updated 8/17/11
- Bowel Prep Products - Updated 12/22/10
- Brimondine P - Updated 3/7/11
- Budesonide EC-Updated 10/6/11
- Byetta - Updated 12/22/10
- Calcium Channel Blockers – Dihydropyridines - Updated 12/27/10
- Calcium Channel Blockers – Nondihydropyridines - Updated 8/17/11
- Calcipotriene - Updated 3/25/11
- Caprelsa (Vandetanib) - Updated 10/4/11
- Carbaglu - Updated 8/17/11
- Carisoprodol
- Celestone Soluspan - Updated 12/27/10
- Cephalosporins - 3rd Generation - Updated 11/9/11
- Cialis- Updated 11/9/11
- Ciclopirox Gel - Updated 3/7/11
- Ciclopirox Shampoo - Updated 12/27/10
- Clonidine Injection - Updated 3/7/11
- Clonidine TTS - Updated 3/7/11
- Co-Enzyme_Q10 - Updated 12/27/10
- Colcrys QLL- Updated 11/9/11
- Colony Stimulating Factors - Updated 11/9/11
- Combunox - Updated 12/27/10
- Compound PA Request Form - Updated 12/27/10
- COPD Agents- Updated 10/6/11
- Corticosteroid Combinations - Updated 10/4/11
- Corvita - Updated 3/7/11
- Cosyntropin - Updated 3/7/11
- Crinone - Updated 12/27/10
- Cubicin - Updated 12/27/10
- Cuvposa
- Cyclobenzaprine products
- Cycloserine - Updated 11/9/11
- Cytovene - Updated 3/7/11
- Desonil Plus Kit - Updated 12/27/10
- Diabetic Supplies, Insulin Pens or Cartridges - Updated 11/9/11
- Dificid
- Divista - Updated 12/27/10
- Doribax - Updated 12/27/10
- Doxycycline Oral Suspension - Updated 3/7/11
- Doxycycline Products- Updated 10/6/11
- DPP-4 Inhibitors - Updated 01/05/12
- Egrifta
- Elaprase - Updated 12/27/10
- Emsam - Updated 1/4/12
- Emergency Contraceptives
- Enoxaparin - Updated 3/7/11
- Enzymes for Gaucher Disease
- Epoetin - Updated 12/27/10
- Estrogen-Progestin Combinations
- Etoposide - Updated 12/27/10
- Exemestane
- Extavia - Updated 3/25/11
- Fibric Acid Derivatives - Updated 12/27/10
- Firmagon - Updated 12/27/10
- Flagyl ER - Updated 3/7/11
- Flo-Pred Oral Suspension - Updated 3/7/11
- Fluoroquinolone Otics - Updated 12/27/10
- Fondaparinux
- Forteo - Updated 6/2/11
- Fusilev - Updated 12/27/10
- Gilenya
- Gralise
- Growth Hormones - Updated 9/06/11
- H2 Antagonists - Updated 11/9/11
- H. Pilori Agents
- Halonate Kit - Updated 1/18/11
- HIV Medications - Updated 9/29/11
- Horizant
- HP Acthar
- Hyaltopic Plus Kit
- Hyaluronidase - Updated 1/18/11
- Ibuprofen 400mg and 800mg Kits - Updated 1/18/11
- Imiquimod
- ImmuneGlobulin - Updated 11/9/11
- Increlex - Updated 1/18/11
- Inhaled Steroids - Updated 11/9/11
- Inspra - Updated 1/18/11
- Insulins - Updated 8/23/11
- Interferons - Updated 1/18/11
- Intranasal Antihistamines - Updated 8/23/11
- Invanz - Updated 1/18/11
- Iron Parenteral - Updated 9/02/11
- Isotretinoin - Updated 6/2/11
- Letrozole
- Leukotriene Receptor Antagonist: Singulair, Accolate And Zyflo - Updated 10/6/11
- Lido-Hydro Gel - Updated 1/18/11
- Lidoderm Patch - Updated 1/18/11
- Liothyronine - Updated 3/25/11
- Long Acting Narcotics - Updated 12/7/11
- Lotemax Ointment
- Low Sedating Antihistamines And Combination Products - Updated 8/16/11
- Lovaza - Updated 1/18/11
- Lupron Depot - Updated 1/4/12
- Lysteda - Updated 1/18/11
- Macrolides-Ketolides - Updated 3/25/11
- Magnacet and Perloxx - Updated 1/24/11
- Makena
- Meglitinides
- Megace ES - Updated 3/25/11
- Merrem - Updated 1/24/11
- Mesalamine Products - Updated 3/25/11
- Metaxalone
- Metformin Products - Updated 3/25/11
- Methadone - Updated 1/24/11
- Methylergonovine - Updated 10/6/11
- Metozolv ODT - Updated 1/24/11
- Milrinone
- Minocin PAC - Updated 3/25/11
- Mirapex ER
- Miscellaneous Analgesics - Updated 12/7/11
- Miscellaneous Otic Drops - Updated 1/24/11
- Momexin Kit - Updated 1/24/11
- Moxatag - Updated 3/25/11
- Mozobil - Updated 1/24/11
- Multaq - Updated 11/9/11