The 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.
Prior Authorization (PA) Request Process Guide - Updated 04/16/13
Drug/Drug Category by Alphabetical listing (A-M | N - Z)
A B C D E F G H I J K L M N O P Q R S T U V W X Y 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 09/13/12
- Agents for BPH - Updated 11/9/11
- Alinia QLL - Posted 05/02/12
- Aliskiren and Combinations - Updated 07/11/12
- Anticoagulants, Oral - Updated 03/19/13
- Alpha -1 Proteinase Inhibitors - Updated 12/8/11
- Altabax - Updated 12/22/10
- Amevive - Updated 12/22/10
- Aminocaproic Acid - Updated 04/11/13
- Amitiza - Updated 12/22/10
- Amoxicillin Clavulanate - Updated 11/9/11
- Ampyra - Updated 10/10/12
- Anabolic Steroids/Androgens - Updated 8/17/11
- Angiotensin Receptor Blockers - Updated 08/22/12
- Angiotensin Receptor Blockers and Combinations - Updated 03/15/13
- Antabuse- Updated 11/9/11
- Antiandrogens - Updated 02/27/13
- Anticoagulants Injectable - Posted 08/20/12
- Anticonvulsants - Updated 03/26/13
- Antidementia Drugs-Updated 03/21/12
- Antiemetics - Updated 03/19/13
- Antihyperkinesis Agents - Updated 03/26/13
- Antimalarials - Updated 10/12/12
- Antiparkinson Agents - Posted 02/06/13
- Antiplatelet Drugs - Updated 08/22/12
- Antipsoriatic Agents - Updated 01/11/13
- Apraclonidine - Updated 2/14/11
- Arcalyst Ilaris - Updated 12/22/10
- Atypical Antipsychotics - Updated 03/07/13
- Atypical Antipsychotics Prior Authorization Request Form - Updated 05/02/13
- Augmentin XR - Updated 2/14/11
- Azasite - Updated 12/22/10
- Azor - Updated 04/11/13
- Aztreonam - Updated 11/9/11
- Benzodiazepines - Updated 12/22/10
- Benzoyl Peroxide - Updated 04/01/13
- Beta Agents Short Acting Inhalers - Updated 8/23/11
- Beta Adrenergic Nebulizer Agents - Updated 11/28/12
- Beta Blockers - Updated 12/22/10
- BiDil - Updated 12/22/10
- Bile Acid Sequestrants - Updated 03/21/12
- Bone Ossification Suppression - Updated 01/11/13
- Bowel Preparation Products - Updated 02/06/13
- Brimondine P - Updated 3/7/11
- Butorphanol Nasal Spray QLL - Posted 05/02/12
- Byetta and Bydureon - Updated 03/01/13
- Calcium Channel Blockers - Dihydropyridines- Updated 04/11/13
- Calcium Channel Blockers - Nondihydropyridines - Updated 03/01/12
- Caprelsa (Vandetanib) - Updated 10/4/11
- Carbaglu - Updated 8/17/11
- Celestone Soluspan - Updated 12/27/10
- Cephalosporins - 3rd Generation - Updated 02/06/13
- Cevimeline - Posted 02/22/13
- Cialis - Updated 02/25/13
- Clindamycin in D5W - Posted 04/16/13
- Clonidine TTS - Updated 3/7/11
- Co-Enzyme_Q10 - Updated 12/27/10
- Colcrys QLL - Updated 05/02/12
- Colony Stimulating Factors - Updated 11/9/11
- Combunox - Updated 12/27/10
- Compound PA Request Form - Updated 01/24/13
- Contraceptives - Posted 07/11/12
- COPD Agents - Updated 10/15/12
- Corifact - Posted 10/15/12
- Corticosteroid Combinations - Updated 10/4/11
- Corvita - Updated 3/7/11
- Crinone - Updated 12/27/10
- Cromolyn Sodium Oral - Posted 03/01/12
- Cubicin - Updated 12/27/10
- Cuvposa
- Cycolpentolate - Posted 08/20/12
- Cytovene - Updated 3/7/11
- Diabetic Supplies, Insulin Pens or Cartridges - Updated 04/17/12
- 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 04/11/13
- Egrifta
- Elaprase - Updated 12/27/10
- Emsam - Updated - 01/04/12
- Emergency Contraceptives - Updated 10/15/12
- Enzymes for Gaucher Disease - Updated 08/22/12
- Epoetin - Updated 11/28/12
- Erivedge -Posted 03/21/12
- Estrogen-Progestin Combinations
- Etoposide - Updated 12/27/10
- Femring QLL - Posted 05/02/12
- Ferriprox - Posted 03/21/12
- Fibric Acid Derivatives - Updated 02/22/13
- Firmagon - Updated 04/11/13
- Flagyl ER - Updated 3/7/11
- Fluocinolone Otic - Posted 02/29/12
- Fluoroquinolone Otics - Updated 12/27/10
- Forteo - Updated 6/2/11
- Fulyzaq - Posted 05/02/13
- Fusilev - Updated 12/27/10
- Gabapentin Products - Posted 08/20/12
- Gattex - Posted 04/16/13
- Giazo - Posted 04/01/13
- Growth Hormones - Updated 03/21/12
- H2 Antagonists - Updated 11/9/11
- H. Pylori Agents
- Halonate Kit - Updated 1/18/11
- HIV Medications - Updated 03/15/13
- HP Acthar - Updated 03/19/13
- Hyaluronidase - Updated 1/18/11
- Ibuprofen 400mg and 800mg Kits - Updated 1/18/11
- Imiquimod
- Immune Globulin - Updated 03/07/13
- Increlex - Updated 1/18/11
- Inhaled Steroids - Updated 01/11/13
- Inlyta - Posted 05/23/12
- Inspra - Updated 1/18/11
- Insulins - Updated 07/11/12
- Interferons - Updated 1/18/11
- Intranasal Antihistamines - Updated 10/12/12
- Invanz - Updated 1/18/11
- Iron Parenteral - Updated 9/02/11
- Isotretinoin - Updated 03/07/13
- Juxtapid - Posted 04/16/13
- Kalydeco - Posted 04/17/12
- Korlym - Posted 05/23/12
- Kristalose - Posted 02/29/12
- Kynamro - Posted 04/16/13
- Letrozole
- Leukotriene Modifiers - Updated 01/11/13
- Lido-Hydro Gel - Updated 1/18/11
- Lidocaine Topical Products - Updated 03/21/12
- Linzess - Posted 12/27/12
- Long Acting Narcotics - Updated 04/01/13
- Low Sedating Antihistamines And Combination Products - Updated 04/16/13
- Lovaza - Updated 1/18/11
- Lupron Depot - Updated 1/4/12
- Macrolides-Ketolides - Updated 03/15/13
- Makena - Updated 08/20/12
- Meglitinides
- Megace ES - Updated 3/25/11
- Merrem - Updated 1/24/11
- Mesalamine Products - Updated 05/02/13
- Metformin Products - Updated 02/29/12
- Methadone - Updated 1/24/11
- Metozolv ODT - Updated 1/24/11
- Milrinone
- Minocin PAC - Updated 3/25/11
- Miscellaneous Analgesics - Updated 08/22/12
- 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
- Multiple Sclerosis Agents - Posted 05/02/13
- Mupirocin Cream - Posted 04/15/13