Prior Authorization Process and Criteria

 

Pharmacist

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.

If the drug cannot be located by name or if you are unsure of the drug category in which the drug is located, please see the attached Prior Authorization (PA) Cross Reference document for assistance.

 

Prior Authorization (PA) Cross Reference -- Updated 04/12/22

Prior Authorization (PA) Request Process Guide - Updated 1/30/20

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 and Combinations - Updated 03/21/19
• Acne and Rosacea Agents Topical - Updated 09/08/21
• Acromegaly_Agents - Updated 06/28/19
• Afinitor - Updated 08/23/19
• Aliskiren and Combinations - Updated 06/29/17
• Alzheimer Agents - Updated 1/24/2020
• Amyotrophic Lateral Sclerosis - Posted 6/28/19
• Anabolic Steroids/Androgens - Updated 03/31/16
• Analgesics, Narcotics Long - Posted 1/3/20
• Analgesics, Narcotics Short - Updated 09/21/21
• Analgesics, Salicylates - Posted 2/20/20
• Androgenic Agents Injectable - Posted 8/14/19
• Androgenic Agents Oral - Posted 8/14/19
• Androgenic Agents Topical - Updated 09/08/21
• Angiotensin Receptor Blockers and Combinations  - Updated 12/07/20
• Anthelmintics - Updated 12/11/19
• Antiallergens, Oral - Posted 01/28/21
• Antiarrhythmics, Oral PA Summary - Posted 11/24/20
• Antibiotics, GI - Updated 09/21/21
• Antibiotics, Inhaled - Posted 08/10/21
• Antibiotics, Topical - Posted 01/28/21
• Antibiotics, Vaginal - Updated 12/01/20
• Anticholinergics-Antispasmodics - Updated 09/21/21
• Anticoagulants  - Updated 08/10/21
• Anticonvulsants - Updated 4/26/21
• Antidepressants - Updated 12/01/20
• Antidiabetic Agents  - Updated 08/10/21
• Antidiarrheals - Posted 12/07/20
• Antiemetics/Antivertigo Agents  - Updated 08/10/21
• Antifibrinolytic Agents - Posed 11/30/20
• Antifungals Injectable - Posted 2/21/20
• Antifungals Oral - Posted 2/21/20
• Antifungals Topical - Posted 2/21/20
• Antihistamines - Posted 06/18/19
• Antihistamines Nasal - Posted 6/27/19
• Antihyperuricemics  - Updated 01/28/21
• Antimalarials  - Updated 06/18/19
• Antimigraine Agents, Other - Updated 07/23/21
• Antimigraine Agents, Triptans - Posted 12/01/20
• Antiparkinson Agents - Updated 07/23/21
• Antiparasitics, Topical - Updated 09/21/21
• Antiplatelet Drugs - Updated 08/22/19
• Antiprotozoals - Updated 08/10/21
• Antipruritics Topical - Posted 7/3/19
• Antipsoriatic Agents - Updated 06/26/19
• Antivirals Oral - Posted 1/3/20
• Antivirals Topical - Posted 6/19/19
• Anxiolytics Benzodiazepines and Barbiturates - Updated 8/22/19
• Asthma and COPD Agents - Updated 02/01/21
• Atypical Antipsychotics - Updated 09/21/21
  • Atypical Antipsychotics Prior Authorization Request Form - Updated 02/01/21
• Augmentin Products - Posted 08/02/18
• Aztreonam - Updated 05/19/17

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• Balversa - Posted 10/3/19
• Basal Cell Carcinoma Agents - Posted 05/06/16
• Beta Blockers - Updated 08/22/19
• Bile Acid Sequestrants - Updated 12/03/15
• Bile Salts - Posted 09/08/21
• Biologic Immunomodulators  - Updated 09/21/21
• Bladder Relaxant Preparations - Updated 09/21/21
• Bone Resorption Suppression - Updated 09/08/21
• BPH Agents - Updated 2/20/20

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• Cabometyx - Posted 06/18/19
• Calcium Channel Blockers - Posted 1/3/20
• Capecitabine - Posted 09/21/15
• Carbaglu - Updated 8/17/11
• Carbapenems - Posted 09/09/16
• Celestone Soluspan - Updated 12/27/10
• Cephalosporins Related Antibiotics - Posted 2/20/20
• Cephalosporins, Injectable - Posted 2/20/20
• Chelating Agents - Updated 01/3/20
• Chenodal  - Posted 01/23/19
• Cholbam - Posted 05/06/16
• Clonidine TTS - Updated 3/7/11
• Colony Stimulating Factors - Updated 09/21/21
• Compound PA Request Form - Updated 12/12/18
• Contraceptives - Updated 12/01/20
• Corlanor - Posted 01/3/20
• Corticosteroid Combinations - Updated 10/18/17
• Corticosteroids Oral - Updated 12/1/19
• Corticosteroids Topical - Updated 09/08/21
• Corvita - Updated 01/19/18
• Crinone - Updated 12/27/10
• Cystic Fibrosis, Oral  - Updated 09/21/21
• Cytomegalovirus Agents  - Posted 6/27/19

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• Daurismo - Posted 6/28/19
• Diabetic Supplies, Insulin Pens  - Updated 07/23/21
• Diarrhea Agent - Posted 07/10/17
• Diuretics - Updated 08/10/21

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• Egrifta  - Updated 06/28/17
• Elaprase - Updated 12/27/10
• Emflaza Prior Authorization Request Form - Updated 12/12/18
• Enzymes for Gaucher Disease - Updated 01/27/15
• Enzyme Inhibitors Systemic - Posted 10/15/21
• Epinephrine Injection - Updated 12/10/19
• Epoetin - Updated 01/31/19
• Estrogen Agents, Oral-Transdermal  - Updated 12/01/20
• Etoposide - Updated 7/10/19

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• Fabry Disease Agents - Posted 6/28/19
• Femring QLL  - Posted 05/02/12
• Fibric Acid Derivatives - Updated 08/2/18
• Firmagon - Updated 04/11/13

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• Gattex - Posted 04/16/13
• GI Motility, Chronic PA - Updated 12/01/20
• Glycopeptides  - Posted 06/10/16
• Growth Hormones - Updated 06/28/17

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• H. Pylori Agents  - Updated 12/01/20
• H2 Antagonists - Updated 12/01/20
• Hemophilia Treatment - Updated 10/05/21
  • ​ Hemlibra Prior Authorization Form - Updated 8/5/19
• Hepatitis B Agents - Updated 7/10/19
• Hepatitis C Agents - Updated 09/08/21
  • Hepatitis C Retreatment Form - Updated 7/23/19
• ​HAE Treatments  - Updated 10/15/21
• Hereditary Transthyretin Amyloidosis Agents - Posted 9/6/19 
• HIV-AIDS Medications - Updated 09/08/21
• HP Acthar - Updated 04/3/17
• Hyaluronidase - Updated 1/18/11
• Hyperhidrosis Agent - Posted 8/14/19
• Hyperkalemia Agents - Posted 6/18/19
• Hypoglycemics Insulin and Related Agents - Updated 07/23/21
• Hypophosphatemia Treatments - Posted 11/30/20

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• Immune Globulin - Updated 08/22/19
• Immunomodulators, Lupus - Posted 10/05/21
• Immunosuppressives Oral - Updated 6/27/19
• Increlex - Updated 1/18/11
• Inlyta  - Updated 07/10/18
• Invanz - Updated 1/18/11
• Iron, Oral - Posted 02/01/21
• Iron Parenteral - Updated 09/27/18
• Isotretinoin - Updated 10/28/13

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• Jynarque - Posted 9/28/18

• Keveyis - Posted 05/05/16
• Korlym  - Posted 05/23/12

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• Lambert-Eaton Myasthenic Syndrome Agents - Posted 12/11/19
• Lanoxin - Posted 04/09/14
• Laxatives and Cathartics - Posted 12/10/19
• Leukotriene Modifiers - Updated 12/11/19
• Lidocaine Topical Products - Updated 08/23/19
• Lipopeptides - Posted 6/28/19
• Lipotropics, Other - Updated 08/10/21
• Lipotropics, Statins - Posted 12/01/20
  • Lipotropics, Satins PA Appeal Form - Posted 2/20/20
• Lonsurf - Posted 07/10/19

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• Macrolides-Ketolides  - Updated 02/20/20
• Makena - Updated 11/01/16
  • ​ Universal 17-P Auth Form - Updated 10/30/18
• Megace ES - Updated 03/30/16
• Melanoma Agents - Updated 1/23/19
• Methotrexate_Products - Posted 10/12/17
• Milrinone
• Miscellaneous Analgesics - Updated 06/28/19
• Movement Disorder - Updated 04/19/22
• Mozobil - Updated 1/24/11
• Multiple Sclerosis Agents - Updated 08/10/21
• Myalept - Updated 08/20/15

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Prior Authorization Process and Criteria - Related Links

Prior Authorization Process and Criteria - Related Links

• Prior Authorization Criteria N - Z