Prior Authorization Process and Criteria
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 3/16/20
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 6/27/19
- Acromegaly_Agents - Updated 06/28/19
- Afinitor - Updated 08/23/19
- Aliskiren and Combinations - Updated 06/29/17
- Allergic Rhinitis Sublingual Immunotherapy -- Posted 01/06/15
- Alpha -1 Proteinase Inhibitors - Updated 04/10/14
- 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 8/22/19
-
Analgesics, Salicylates
- Posted 2/20/20
- Androgenic Agents Injectable - Posted 8/14/19
- Androgenic Agents Oral - Posted 8/14/19
- Androgenic Agents Topical - Updated 02/20/20
- Angiotensin Receptor Blockers and Combinations - Updated 06/26/19
- Anthelmintics - Updated 12/11/19
- Antiandrogens - Updated 8/23/19
- Antibiotics Vaginal - Updated 8/22/19
- Anticholinergics-Antispasmodics - Updated 2/20/20
- Anticoagulants - Updated 1/24/20
- Anticonvulsants - Updated 1/24/20
- Antidepressants - Updated 06/27/19
- Antidiabetic Agents - Updated 2/20/20
- Antiemetics - Updated 6/28/19
-
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
- Antimalarials - Updated 06/18/19
- Antimigraine Agents - Posted 1/24/20
-
Antibiotics, GI
- Posted 2/20/20
- Antiparkinson Agents - Updated 1/24/20
-
Antiparasitics Topical
- Posted 12/27/19
- Antiplatelet Drugs - Updated 08/22/19
- Antiprotozoals - Posted 01/23/19
- 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
- Arikayce - Posted 6/27/19
- Asthma and COPD Agents - Updated 01/3/20
- Atypical Antipsychotics - Updated 1/24/20
- Atypical Antipsychotics Prior Authorization Request Form - Updated 12/30/19
- Augmentin Products - Posted 08/02/18
- Aztreonam - Updated 05/19/17
-
Balversa
- Posted 10/3/19
- Basal Cell Carcinoma Agents - Posted 05/06/16
- Beta Blockers - Updated 08/22/19
- BiDil - Updated 12/22/10
- Bile Acid Sequestrants - Updated 12/03/15
- Biologic Immunomodulators - Updated 1/24/20
- Bladder Relaxant Preparations - Posted 6/27/19
- Bone Ossification Suppression - Updated 06/05/18
- BPH Agents - Updated 2/20/20
- 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 1/24/20
- Compound PA Request Form - Updated 12/12/18
- Contraceptives - Updated 12/10/19
- Copiktra - Posted 6/27/19
- Corlanor - Posted 01/3/20
- Corticosteroid Combinations - Updated 10/18/17
- Corticosteroids Oral - Updated 12/1/19
-
Corticosteroids Topical
- Posted 12/10/19
- Corvita - Updated 01/19/18
- Crinone - Updated 12/27/10
- Cystic Fibrosis, Oral - Updated 11/9/19
- Cytomegalovirus Agents - Posted 6/27/19
- Daurismo - Posted 6/28/19
- Diabetic Supplies, Insulin Pens or Cartridges - Updated 12/11/19
- Diarrhea Agent - Posted 07/10/17
-
Diuretics
- Posted 2/21/20
- 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
- Epinephrine Injection - Updated 12/10/19
- Epoetin - Updated 01/31/19
- Estrogen Modifiers - Updated 10/27/17
- Etoposide - Updated 7/10/19
- 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
- Gattex - Posted 04/16/13
- GI Motility, Chronic PA - Updated 1/24/20
- Glycopeptides - Posted 06/10/16
- Gonadotropin Releasing Hormone - Posted 6/28/19
- Gout Agents - Updated 06/27/19
- Growth Hormones - Updated 06/28/17
- H. Pylori Agents - Updated 03/25/16
- H2 Antagonists - Updated 03/25/16
- Hemophilia Treatment - Updated 6/28/19
- Hemlibra Prior Authorization Form - Updated 8/5/19
- Hepatitis B Agents - Updated 7/10/19
- Hepatitis C Agents - Updated 07/23/19
- Hepatitis C Retreatment Form- Updated 7/23/19
- HAE Treatments - Updated 1/17/20
- Hereditary Transthyretin Amloidosis Agents - Posted 9/6/19
-
HIV-AIDS Medications
- Updated 11/6/19
- 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 8/22/19
- Immune Globulin- Updated 08/22/19
- Immunosuppressives Oral - Updated 6/27/19
- Increlex - Updated 1/18/11
- Inlyta - Updated 07/10/18
- Invanz - Updated 1/18/11
- Iron Parenteral - Updated 09/27/18
- Isotretinoin - Updated 10/28/13
- Jynarque - Posted 9/28/18
- 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
- Posted 2/20/20
-
Lipotropics, Statins
- Posted 2/20/20
-
Lipotropics, Satins PA Appeal Form
- Posted 2/20/20
-
- Lonsurf - Posted 07/10/19
- 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
- Metozolv ODT - Updated 03/30/16
- Milrinone
- Miscellaneous Analgesics - Updated 06/28/19
- Movement Disorder - Updated 1/27/20
- Mozobil - Updated 1/24/11
- Multaq - Updated 11/9/11
- Multiple Sclerosis Agents - Updated 01/27/20
- Myalept - Updated 08/20/15