
Prior Authorization Criteria N - Z

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.
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
-
Narcotic Fill Limit - Posted 04/01/13
-
Narcotics Long Acting - Updated 7/8/19
-
Nasal Antihistamines - Updated 8/22/19
-
Naloxone Products - Posted 09/14/16
-
Nasal Steroids - Updated 7/02/19
-
Natpara - Posted 05/26/16
-
Neuropathic Pain - Updated 04/18/22
-
Nexavar - Posted 7/10/19
-
Northera - Posted 03/30/16
-
NSAID and COX II - Updated 06/18/19
-
NSAIDs, Topical - Posted 1/27/20
-
Nuedexta
-
Ocaliva - Posted 06/13/18
-
Oncology Oral-Breast - Posted 12/10/19
-
Oncology Oral-Hematologic - Updated 10/15/21
-
Oncology Oral-Ovarian - Updated 8/14/19
-
Oncology Oral Lung - Updated 10/15/21
-
Oncology Oral-Prostate - Posted 10/15/21
-
Ophthalmics for Allergic conjunctivitis
- Posted 08/23/19
-
Opthalmic Antibiotics - Updated 01/27/20
-
Ophthalmics Anti-inflammatories - Updated 02/01/21
-
Ophthalmics Anti-inflammatories Immunomodulators - Updated 05/31/22
-
Ophthalmic Antivirals - Posted 03/12/15
-
Ophthalmic Glaucoma Agents - Updated 02/01/21
-
Ophthalmic Steroid Antibiotic Combination - Posted 07/2/19
-
Ophthalmics for Neurotrophic Keratitis
- Posted 8/26/19
-
Opiate Dependence Agents - Updated 06/03/22
-
Opioid MME Maximum PA Form - Updated 10/4/19
-
Orfadin - Posted 10/13/16
-
Otic Antibiotics - Posted 1/27/20
-
Oxazolidinones - Posted 05/06/16
-
Palynziq - Posted 8/26/19
-
Pancreatic Enzymes - Updated 07/05/22
-
Panretin - Updated 1/24/11
-
Parenteral Nutrition Products -Posted Updated 08/26/19
-
Pheochromocytoma Agents - Posted 10/15/21
-
Phosphate Binders - Updated 12/10/19
-
Pituitary Suppressive Agents - Updated 05/30/22
-
Pleuromutilin Antibiotics - Posted 12/07/20
-
Potassium Binders - Posted 06/06/22
-
Primary Hyperoxaluria Agents - Posted 10/15/21
-
Procysbi - Posted 11/22/13
-
Proton Pump Inhibitors - Updated 12/01/20
-
Proton Pump Inhibitors PA Request Form - Updated 11/04/20
-
-
Pulmonary Artery Hypertension Agents - Updated 10/15/21
-
Pulmonary Fibrosis Agents - Updated 01/27/20
-
Pyridostigmine - Posted 12/10/19
-
Quinolones - Updated 9/27/18
-
Ranolazine - Posted 1/3/20
-
Ravicti - Posted 06/28/19
- Rectiv - Posted 04/17/12
-
Regranex - Updated 1/24/11
-
Santyl - Posted 02/06/13
-
Sedative Hypnotics - Updated 01/26/22
- Serostim - Updated 1/14/09
-
Sickle Cell Agents - Updated 04/01/22
-
Signifor - Posted 06/28/19
-
Sirturo - Posted 11/22/13
-
Skeletal Muscle Relaxants - Updated 02/20/20
- Spinal Muscular Atrophy Agents - Posted 04/26/21
-
Stimulants and Related Agents - Updated 03/01/22
-
Stivarga - Updated 10/12/17
-
Strensiq - Posted 05/26/16
-
Sutent - Updated 07/10/18
-
Synagis Policy for RSV Season '22-'23 - Posted 11/14/22
-
Synagis - PA Summary - Updated 10/05/21
-
Synagis - PA Request Form - Updated 10/04/21
-
Synagis - MAR - Updated 9/13/18
-
Synagis - FAQ - Posted 9/6/18
-
-
Synribo - Updated 01/19/18
-
Temozolomide - Posted 7/8/19
-
Tetracyclines - Updated 07/23/21
-
Thiola - Posted 12/10/19
-
Thrombopoiesis Stimulating Proteins - Updated 02/01/21
-
Thyroid Hormones - Updated 10/15/21
-
Tobacco Cessation - Updated 08/2/18
-
Tobacco Cessation PA Request Form - Updated 12/12/18
-
-
Tobramycin Inhaled - Updated 06/28/17
-
Topical Antineoplastic and Genital Warts - Updated 07/03/19
-
Topical NSAIDs - Updated 07/03/19
-
Transmucosal Fentanyl - Updated 11/30/20
- Trelstar - Updated 8/18/10
-
Turalio - Posted 1/3/20
-
Tygacil - Updated 09/02/2011
- Tyzeka
-
Ulcerative Colitis Agents - Posted 8/22/19
- Urea Products - Updated 2/2/11
-
Urinary Antiinfectives - Updated 02/21/20
-
Urocit K - Updated 02/25/14
-
Vaginal Estrogen Preparations - Posted 07/05/22
-
Vasodilators, Coronary - Updated 08/10/21
-
Vecamyl - Posted 02/24/14
-
Vitamin D and ESRD Products - Updated 09/08/21
-
Vitrakvi - Posted 7/10/19
-
Vimizim - Posted 03/30/16
-
Votrient - Updated 08/22/12
-
Vyndaqel-Vyndamax - Posted 1/8/20