Physician Specialty Overview by Prior Authorization ......3963 HEMATOLOGY Aranesp HEMATINICS & BLOOD...

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Physician Specialty Overview by Prior Authorization Approval or Denial4th Quarter 2019

9431 4/20

Carrier Prescriber Primary Specialty Description Drug SPECIALTY CODE DESCRIPTION Decision Count

3951 DERMATOLOGY Absorica (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3952 FAMILY PRACTICE Absorica (isotretinoin) DERMATOLOGICAL AGENTS No Response 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica (isotretinoin) DERMATOLOGICAL AGENTS Approval 2

3951 FAMILY PRACTICE Absorica 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica 30MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Absorica 30MG OR CAPS DERMATOLOGICAL AGENTS Approval 2






3951 PRESCRIBER SPECIALTY, UNKNOWN Acamprosate Calcium 333MG OR TBEC SUBSTANCE ABUSE AGENTS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Acamprosate Calcium 333MG OR TBEC SUBSTANCE ABUSE AGENTS Approval 1

3956 FAMILY PRACTICE Acamprosate Calcium 333MG OR TBEC SUBSTANCE ABUSE AGENTS Approval 5

3963 FAMILY PRACTICE acetaminophen 300 mg-codeine 30 mg tablet (TYLE-NOL #3) NARCOTIC ANALGESICS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Acetaminophen-Codeine #3 300-30MG OR TABS NARCOTIC ANALGESICS No Response 1

3956 FAMILY PRACTICE Acetaminophen-Codeine #4 300-60MG OR TABS NARCOTIC ANALGESICS Approval 1

3963 DERMATOLOGY Acitretin 10MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Acitretin 25MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3956 RHEUMATOLOGY Actemra IMMUNOSUPPRESSIVES/DMARDS Approval 1

3961 PRESCRIBER SPECIALTY, UNKNOWN Actemra IMMUNOSUPPRESSIVES/DMARDS No Response 1

3961 INTERNAL MEDICINE Actemra IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 INTERNAL MEDICINE Acthar Gel ANTICONVULSANTS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX CREA ANTIVIRALS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX CREA ANTIVIRALS Approval 1

3963 FAMILY PRACTICE Acyclovir 5% EX CREA ANTIVIRALS Approval 1

3963 NURSE PRACTITIONER, UNSPECIFIED Acyclovir 5% EX CREA ANTIVIRALS Approval 1

3951 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS Approval 1


2


3952 OBSTETRICS & GYNECOLOGY Acyclovir 5% EX OINT ANTIVIRALS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX OINT ANTIVIRALS Approval 2

3963 DENTIST, GENERAL PRACTICE Acyclovir 5% EX OINT ANTIVIRALS Approval 2


3963 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS No Response 2

3963 NURSE PRACTITIONER, FAMILY HEALTH Acyclovir 5% EX OINT ANTIVIRALS Approval 1

3963 NURSE PRACTITIONER, UNSPECIFIED Acyclovir 5% EX OINT ANTIVIRALS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Acyclovir 5% EX OINT ANTIVIRALS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir Cream ANTIVIRALS Approval 1

3963 FAMILY PRACTICE Acyclovir Cream ANTIVIRALS Approval 1

3963 PHYSICIAN, SURGERY, GENERAL Acyclovir Cream ANTIVIRALS Denial 1

3951 FAMILY PRACTICE Acyclovir Oint ANTIVIRALS Denial 1

3951 INTERNAL MEDICINE Acyclovir Oint ANTIVIRALS Denial 1

3951 FAMILY PRACTICE Acyclovir Ointment ANTIVIRALS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir Ointment ANTIVIRALS No Response 1

3956 NURSE PRACTITIONER, FAMILY HEALTH Adapalene 0.3% EX GEL DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Adapalene 0.3% EX GEL DERMATOLOGICAL AGENTS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Adapalene 0.3% EX GEL DERMATOLOGICAL AGENTS Approval 1

3956 FAMILY PRACTICE Adapalene Cream DERMATOLOGICAL AGENTS Denial 1

3952 FAMILY PRACTICE Adderall 20MG OR TABS CNS STIMULANTS Approval 1

3956 FAMILY PRACTICE Adderall 30MG OR TABS CNS STIMULANTS Approval 1

3956 PSYCHIATRY, CHILD & ADOLESCENT Adderall 30MG OR TABS CNS STIMULANTS No Response 1

3963 ANESTHESIOLOGY Adderall 30MG OR TABS CNS STIMULANTS Approval 1

3963 INTERNAL MEDICINE Adderall 30MG OR TABS CNS STIMULANTS Approval 1

3956 NEUROLOGY Adderall XR 25MG OR CP24 CNS STIMULANTS No Response 1

3956 NEUROLOGY Adderall XR 30MG OR CP24 CNS STIMULANTS Denial 1

3952 PHYSICIAN, ONCOLOGY, MEDICAL Afinitor ANTINEOPLASTICS Denial 1

3963 MEDICAL ONCOLOGY Afinitor ANTINEOPLASTICS Approval 1

3963 ONCOLOGY, GYNECOLOGIC Afinitor ANTINEOPLASTICS Approval 1

3963 ONCOLOGY, GYNECOLOGIC Afinitor ANTINEOPLASTICS No Response 1

3956 GASTROENTEROLOGY Alosetron GASTROINTESTINAL AGENTS Approval 2

3961 FAMILY PRACTICE Alosetron HCl 0.5MG OR TABS GASTROINTESTINAL AGENTS Denial 1

3963 DERMATOLOGY Altreno 0.05% EX LOTN DERMATOLOGICAL AGENTS Approval 1

3952 DERMATOLOGY Amnesteem (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3956 DERMATOLOGY Amnesteem (isotretinoins) DERMATOLOGICAL AGENTS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem (isotretinoins) DERMATOLOGICAL AGENTS Approval 1

3


3951 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1



3952 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3956 DERMATOLOGY Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS No Response 1

3956 PSYCHIATRY Amphetamine-Dextroamphet ER 20MG OR CP24 CNS STIMULANTS Approval 3

3956 PSYCHIATRY Amphetamine-Dextroamphet ER 20MG OR CP24 CNS STIMULANTS No Response 1

3951 FAMILY PRACTICE Amphetamine-Dextroamphet ER 30MG OR CP24 CNS STIMULANTS Approval 1

3951 PEDIATRICS Amphetamine-Dextroamphet ER 30MG OR CP24 CNS STIMULANTS Approval 1


3956 PSYCHIATRY Amphetamine-Dextroamphet ER 30MG OR CP24 CNS STIMULANTS Approval 1


3963 NEUROLOGY Amphetamine-Dextroamphet ER 30MG OR CP24 CNS STIMULANTS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine 10mg Tab CNS STIMULANTS Denial 1

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 12.5MG OR TABS CNS STIMULANTS Approval 1

3956 GENERAL PRACTICE Amphetamine-Dextroamphetamine 15mg ER CNS STIMULANTS Approval 1

3956 PSYCHIATRY Amphetamine-Dextroamphetamine 15mg ER CNS STIMULANTS Approval 1

3961 FAMILY PRACTICE Amphetamine-Dextroamphetamine 15MG OR TABS CNS STIMULANTS Approval 1

3963 PSYCHIATRY Amphetamine-Dextroamphetamine 15MG OR TABS CNS STIMULANTS Approval 1

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 15mg Tab CNS STIMULANTS No Response 1

3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg CNS STIMULANTS Approval 2

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg ER CNS STIMULANTS Approval 1

3956 PEDIATRICS Amphetamine-Dextroamphetamine 20mg ER CNS STIMULANTS Approval 1


3961 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine 20mg ER CNS STIMULANTS Approval 2

3963 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg ER CNS STIMULANTS No Response 2




3956 PSYCHIATRY, CHILD & ADOLESCENT Amphetamine-Dextroamphetamine 20MG OR TABS CNS STIMULANTS Approval 1

3956 REGISTERED NURSE, UNSPECIFIED Amphetamine-Dextroamphetamine 20MG OR TABS CNS STIMULANTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine 20MG OR TABS CNS STIMULANTS Approval 1



4


3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg Tab CNS STIMULANTS Approval 3

3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg Tab CNS STIMULANTS Approval 2

3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg Tab CNS STIMULANTS No Response 1


3956 NEUROLOGY Amphetamine-Dextroamphetamine 25mg ER CNS STIMULANTS Denial 1


3951 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS STIMULANTS Denial 2

3951 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg CNS STIMULANTS Approval 1


3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS STIMULANTS Denial 1

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg ER CNS STIMULANTS Approval 1






3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS No Response 1


3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS No Response 1

3956 PSYCHIATRY, CHILD & ADOLESCENT Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval 2

3956 REGISTERED NURSE, UNSPECIFIED Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval 1


3961 GENERAL PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval 1




3963 NURSE PRACTITIONER, FAMILY HEALTH Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval 1

3963 NURSE PRACTITIONER, UNSPECIFIED Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval 1


3951 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Approval 1


3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Approval 7

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Denial 3

3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS No Response 3

3956 GENERAL PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Denial 1

3956 PEDIATRICS Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Denial 1


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3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS STIMULANTS Denial 2



3951 PSYCHIATRY Amphetamine-Dextroamphetamine ER 20mg CNS STIMULANTS Approval 1

3951 PSYCHIATRY Amphetamine-Dextroamphetamine ER 20mg CNS STIMULANTS Denial 1

3952 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS STIMULANTS Denial 1

3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS STIMULANTS Approval 2

3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS STIMULANTS Denial 1

3952 PSYCHIATRY Amphetamine-Dextroamphetamine ER 30mg CNS STIMULANTS No Response 1

3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 30mg CNS STIMULANTS Approval 1

3952 INTERNAL MEDICINE Androderm (testosterone transdermal patch) ANDROGENS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Androderm (testosterone transdermal patch) ANDROGENS Approval 1

3952 INTERNAL MEDICINE Androderm 4MG/24HR TD PT24 ANDROGENS No Response 1

3954 FAMILY PRACTICE Androgel (testosterone transdermal gel) ANDROGENS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Androgel (testosterone transdermal gel) ANDROGENS Approval 1

3963 FAMILY PRACTICE Androgel (testosterone transdermal gel) ANDROGENS Approval 1

3951 ENDOCRINOLOGY, DIABETES & METABOLISM AndroGel 20.25 MG/1.25GM(1.62%) TD GEL ANDROGENS Approval 1

3956 ANESTHESIOLOGY APAP/Codeine Tab 300-30 mg NARCOTIC ANALGESICS Approval 1

3963 FAMILY PRACTICE APAP-Codeine Tab 300-30 mg NARCOTIC ANALGESICS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN APAP-Codeine Tab 300-60 mg NARCOTIC ANALGESICS Approval 1

3961 NEUROLOGY Aptiom (eslicarbazepine) ANTICONVULSANTS Approval 1

3952 NEPHROLOGY / RENAL MEDICINE Aranesp HEMATINICS & BLOOD CELL STIMULATORS No Response 1

3963 HEMATOLOGY Aranesp HEMATINICS & BLOOD CELL STIMULATORS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil CNS STIMULANTS Approval 1

3956 NEUROLOGY Armodafinil CNS STIMULANTS Denial 3

3956 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil CNS STIMULANTS Denial 1

3956 PSYCHIATRY Armodafinil CNS STIMULANTS Approval 1

3956 PSYCHIATRY Armodafinil CNS STIMULANTS Denial 2

3956 FAMILY PRACTICE Armodafinil 150 MG Oral Tablet PSYCHOSTIMULANTS-ANTIDEPRESSANTS Approval 1

3952 NURSE PRACTITIONER, UNSPECIFIED Armodafinil 150MG OR TABS CNS STIMULANTS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil 150MG OR TABS CNS STIMULANTS Approval 1

3956 NEUROLOGY Armodafinil 150MG OR TABS CNS STIMULANTS Approval 1

3956 PULMONARY DISEASES Armodafinil 150MG OR TABS CNS STIMULANTS Approval 4

3961 FAMILY PRACTICE Armodafinil 150MG OR TABS CNS STIMULANTS Approval 1


3963 NURSE PRACTITIONER, WOMEN’S HEALTH armodafinil 200 mg tablet CNS STIMULANTS No Response 1

3951 PULMONARY DISEASES Armodafinil 200MG OR TABS CNS STIMULANTS Approval 2

6


3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil 200MG OR TABS CNS STIMULANTS Approval 1

3956 PSYCHIATRY Armodafinil 200MG OR TABS CNS STIMULANTS Approval 1



3963 INTERNAL MEDICINE Armodafinil 200MG OR TABS CNS STIMULANTS Approval 1


3956 NURSE PRACTITIONER, ACUTE CARE Armodafinil 250MG OR TABS CNS STIMULANTS Approval 1

3956 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil 250MG OR TABS CNS STIMULANTS Approval 1

3963 FAMILY PRACTICE Armodafinil 250MG OR TABS CNS STIMULANTS Denial 1


3963 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil 250MG OR TABS CNS STIMULANTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil Tablets CNS STIMULANTS Denial 1

3951 FAMILY PRACTICE Armodafinil Tablets CNS STIMULANTS Denial 1

3951 NURSE PRACTITIONER, UNSPECIFIED Armodafinil Tablets CNS STIMULANTS Approval 1

3951 PULMONARY DISEASES Armodafinil Tablets CNS STIMULANTS Approval 1

3952 NURSE PRACTITIONER, UNSPECIFIED Armodafinil Tablets CNS STIMULANTS Approval 1

3963 FAMILY PRACTICE Armodafinil Tablets CNS STIMULANTS Approval 1

3963 NEUROLOGY Armodafinil Tablets CNS STIMULANTS Approval 1

3952 NURSE PRACTITIONER, FAMILY HEALTH Aubagio MULTIPLE SCLEROSIS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Aubagio MULTIPLE SCLEROSIS No Response 1

3956 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 1

3961 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 1

3961 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Aubagio MULTIPLE SCLEROSIS Approval 1

3963 NURSE PRACTITIONER, UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Denial 2

3956 NEUROLOGY Avonex MULTIPLE SCLEROSIS No Response 1

3961 NEUROLOGY Avonex MULTIPLE SCLEROSIS No Response 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Avonex MULTIPLE SCLEROSIS Approval 1

3956 NEUROLOGY Avonex Pen 30MCG/0.5ML IM AJKT MULTIPLE SCLEROSIS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Azelaic Acid DERMATOLOGICAL AGENTS Approval 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid DERMATOLOGICAL AGENTS Denial 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid DERMATOLOGICAL AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Azelaic Acid DERMATOLOGICAL AGENTS Approval 2

3963 DERMATOLOGY Azelaic Acid DERMATOLOGICAL AGENTS Denial 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED AZELAIC ACID 15% GEL DERMATOLOGICAL AGENTS Approval 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Denial 1

7


3952 DERMATOLOGY Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Approval 1

3952 NURSE PRACTITIONER, UNSPECIFIED Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Denial 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Approval 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Denial 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS Approval 2

3952 PRESCRIBER SPECIALTY, UNKNOWN Belbuca 150MCG BU FILM NARCOTIC ANALGESICS Approval 1

3956 ANESTHESIOLOGY Belbuca 150MCG BU FILM NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca 150MCG BU FILM NARCOTIC ANALGESICS Approval 2

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Belbuca 150MCG BU FILM NARCOTIC ANALGESICS Approval 1

3961 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca 150MCG BU FILM NARCOTIC ANALGESICS No Response 1

3951 GENERAL PRACTICE Belbuca 150mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Belbuca 150mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS Approval 1


3951 ANESTHESIOLOGY Belbuca 300mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS Approval 1

3963 ANESTHESIOLOGY Belbuca 450mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS Approval 1

3963 ANESTHESIOLOGY Belbuca 450mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS Denial 1

3953 ANESTHESIOLOGY Belbuca 600MCG BU FILM NARCOTIC ANALGESICS Denial 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Belbuca 600MCG BU FILM NARCOTIC ANALGESICS Approval 1


3953 ANESTHESIOLOGY Belbuca 600mcg Buccal Film (buprenorphine) NARCOTIC ANALGESICS No Response 1

3956 FAMILY PRACTICE Belbuca 750MCG BU FILM NARCOTIC ANALGESICS Approval 1


3956 FAMILY PRACTICE Belbuca 75MCG BU FILM NARCOTIC ANALGESICS Approval 1



3956 ANESTHESIOLOGY Belbuca 900MCG BU FILM NARCOTIC ANALGESICS No Response 1

3961 EMERGENCY MEDICINE Belbuca 900MCG BU FILM NARCOTIC ANALGESICS Approval 1


3951 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca Mis 300 mcg (buprenorphine buccal film) NARCOTIC ANALGESICS Approval 1

3956 ANESTHESIOLOGY Belbuca Mis 75 mcg (buprenorphine buccal film) NARCOTIC ANALGESICS Approval 1

3956 ANESTHESIOLOGY Belbuca Mis 900 mcg (buprenorphine buccal film) NARCOTIC ANALGESICS Approval 1

3963 FAMILY PRACTICE bosentan VASODILATOR Approval 1

3963 GENERAL PRACTICE bosentan VASODILATOR Approval 1

3963 PEDIATRICS bosentan VASODILATOR Approval 1

3963 PSYCHIATRY bosentan VASODILATOR Approval 1

3961 HEMATOLOGY & ONCOLOGY Bosulif ANTINEOPLASTICS No Response 1

8


3952 PRESCRIBER SPECIALTY, UNKNOWN Braftovi ANTINEOPLASTICS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Braftovi ANTINEOPLASTICS Approval 1

3956 NEUROLOGY Briviact 100MG OR TABS ANTICONVULSANTS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Briviact 50MG OR TABS ANTICONVULSANTS Approval 1

3961 NEUROLOGY Briviact Tablet (brivaracetam) ANTICONVULSANTS Approval 1

3952 GASTROENTEROLOGY BUDESONIDE 0.5MG/2ML AMPUL-NEB RESPIRATORY AGENTS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN BUDESONIDE 1MG/2ML AMPUL-NEB RESPIRATORY AGENTS Denial 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Buprenorphine 15MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1

3963 ANESTHESIOLOGY Buprenorphine 20MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1

3963 INTERNAL MEDICINE Buprenorphine 20MCG/HR TD PTWK NARCOTIC ANALGESICS No Response 1

3956 ANESTHESIOLOGY Buprenorphine HCl 2MG SL SUBL SUBSTANCE ABUSE AGENTS Denial 2

3952 EMERGENCY MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS No Response 1

3956 ANESTHESIOLOGY Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS Denial 1

3956 EMERGENCY MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS Approval 1

3956 FAMILY PRACTICE Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS Denial 2

3956 INTERNAL MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS Denial 2

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS Approval 1

3956 PSYCHIATRY Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS No Response 2

3956 ANESTHESIOLOGY Buprenorphine HCl-Naloxone HCl 8-2MG SL SUBL SUBSTANCE ABUSE AGENTS No Response 1

3956 ANESTHESIOLOGY Buprenorphine SL 2 mg Tab SUBSTANCE ABUSE AGENTS Denial 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 1


3956 FAMILY PRACTICE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 3

3956 GASTROENTEROLOGY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 1

3956 INTERNAL MEDICINE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 6

3956 PEDIATRICS Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 1

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 1

3956 PSYCHIATRY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 2


3963 FAMILY PRACTICE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial 1

3951 FAMILY PRACTICE Buprenorphine Sublingual Tablets SUBSTANCE ABUSE AGENTS Denial 1

3963 EMERGENCY MEDICINE Buprenorphine Sublingual Tablets SUBSTANCE ABUSE AGENTS Denial 1

3956 NURSE PRACTITIONER, FAMILY HEALTH BUTALBITAL-ACETAMINOPHEN-CA--325-40-50 NON-NARCOTIC ANALGESICS No Response 1

3956 ANESTHESIOLOGY Butorphanol Tartrate 10MG/ML NA SOLN NARCOTIC ANALGESICS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Butrans 15MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1

3951 NURSE PRACTITIONER, FAMILY HEALTH Butrans 15MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1

9


3952 FAMILY PRACTICE Butrans 15MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1


3951 ANESTHESIOLOGY Butrans 20mcg/hr TD Patch (buprenorphine) NARCOTIC ANALGESICS Approval 1

3951 FAMILY PRACTICE Butrans 20mcg/hr TD Patch (buprenorphine) NARCOTIC ANALGESICS No Response 1


3952 PAIN MEDICINE Butrans 20MCG/HR TD PTWK NARCOTIC ANALGESICS Approval 1


3963 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS Approval 1

3963 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS No Response 1

3956 HEMATOLOGY & ONCOLOGY Calquence ANTINEOPLASTICS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS Approval 1

3951 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS No Response 1

3952 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS No Response 1


3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Approval 2

3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Denial 1

3956 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Approval 2

3956 MEDICAL ONCOLOGY capecitabine ANTINEOPLASTICS Approval 2

3956 MEDICAL ONCOLOGY capecitabine ANTINEOPLASTICS No Response 1


3963 HEMATOLOGY capecitabine ANTINEOPLASTICS Approval 1

3963 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Approval 1

3963 PHYSICIAN, ONCOLOGY, MEDICAL capecitabine ANTINEOPLASTICS Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cerdelga ENZYME INHIBITOR Approval 1

3956 FAMILY PRACTICE CHANTIX 1MG TABLET SMOKING CESSATION AGENTS No Response 1

3956 FAMILY PRACTICE Cialis 5MG OR TABS VASODILATORS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox (topical solution 8%) ANTIFUNGALS Denial 1

3951 DERMATOLOGY Ciclopirox (topical solution 8%) ANTIFUNGALS Denial 1


3952 PODIATRIST, PRIMARY MEDICINE Ciclopirox (topical solution 8%) ANTIFUNGALS Denial 1


3963 DERMATOLOGY Ciclopirox (topical solution 8%) ANTIFUNGALS Approval 1

3963 FAMILY PRACTICE Ciclopirox (topical solution 8%) ANTIFUNGALS Denial 4

3951 FAMILY PRACTICE CICLOPIROX 8% SOL ANTIFUNGALS Approval 1

3951 DERMATOLOGY Ciclopirox 8% EX SOLN ANTIFUNGALS Approval 1

3951 PODIATRIST, PRIMARY MEDICINE Ciclopirox 8% EX SOLN ANTIFUNGALS No Response 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox 8% EX SOLN ANTIFUNGALS Approval 1

10


3952 FAMILY PRACTICE Ciclopirox 8% EX SOLN ANTIFUNGALS No Response 2

3952 PODIATRIST, PRIMARY MEDICINE Ciclopirox 8% EX SOLN ANTIFUNGALS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox 8% EX SOLN ANTIFUNGALS No Response 1

3963 FAMILY PRACTICE Ciclopirox 8% EX SOLN ANTIFUNGALS No Response 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox Kit 8% ANTIFUNGALS Denial 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Ciclopirox Kit 8% ANTIFUNGALS Denial 1

3956 INTERNAL MEDICINE cinacalcet SYSTEMIC HORMONAL AGENTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin) DERMATOLOGICAL AGENTS No Response 1

3951 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 1


3952 FAMILY PRACTICE Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 1


3963 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin) DERMATOLOGICAL AGENTS Denial 1


3963 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS Denial 1

3963 EMERGENCY MEDICINE Claravis (isotretinoin) DERMATOLOGICAL AGENTS Approval 1

3963 EMERGENCY MEDICINE Claravis (isotretinoin) DERMATOLOGICAL AGENTS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis 20MG OR CAPS DERMATOLOGICAL AGENTS No Response 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1


3951 DERMATOLOGY CLARAVIS 30MG CAP DERMATOLOGICAL AGENTS Approval 1

3951 DERMATOLOGY Claravis 30MG OR CAPS DERMATOLOGICAL AGENTS Approval 3







3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 40MG OR CAPS DERMATOLOGICAL AGENTS No Response 1





11


3963 NURSE PRACTITIONER, UNSPECIFIED Claravis 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Clindamycin-Tretinoin 1.2-0.025% EX GEL DERMATOLOGICAL AGENTS Approval 1

3956 NEUROLOGY Clobazam ANTICONVULSANTS Denial 3

3956 NEUROLOGY, PEDIATRIC Clobazam ANTICONVULSANTS Denial 1

3956 NEUROLOGY cloBAZam 10MG OR TABS ANTICONVULSANTS Approval 1

3951 GASTROENTEROLOGY Codeine Sulfate 30mg Tablets NARCOTIC ANALGESICS Denial 1

3952 FAMILY PRACTICE Continuous Blood Glucose DEVICES Denial 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Continuous Blood Glucose DEVICES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Continuous Blood Glucose DEVICES Denial 1

3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES Approval 1

3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES Denial 1

3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES No Response 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Continuous Blood Glucose DEVICES Denial 1

3956 NEUROLOGY Copaxone 20mg MULTIPLE SCLEROSIS Approval 1

3956 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS No Response 1

3961 NURSE PRACTITIONER, FAMILY HEALTH Copaxone 40mg MULTIPLE SCLEROSIS Approval 1

3963 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Approval 1

3963 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Denial 1

3963 DERMATOLOGY Cordran (Brand Only) (flurandrenolide) Tape DERMATOLOGICAL AGENTS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1


3952 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response 1

3956 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1

3956 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 1

3956 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response 2

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1

3956 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval 4

3956 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response 1

3961 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1



3963 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response 1

3963 FAMILY PRACTICE Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response 1

12


3963 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1

3956 RHEUMATOLOGY Cosentyx Sensoready Pen 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1

3951 NURSE PRACTITIONER, FAMILY HEALTH dalfampridine ER MULTIPLE SCLEROSIS Approval 2

3956 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS Approval 1

3956 NURSE PRACTITIONER, FAMILY HEALTH Daliresp (roflumilast) RESPIRATORY AGENTS Approval 1

3956 PULMONARY DISEASES Daliresp 250MCG OR TABS RESPIRATORY AGENTS Approval 2

3956 FAMILY PRACTICE Daliresp 500MCG OR TABS RESPIRATORY AGENTS Approval 1

3956 NURSE PRACTITIONER, UNSPECIFIED Daliresp 500MCG OR TABS RESPIRATORY AGENTS Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Daliresp 500MCG OR TABS RESPIRATORY AGENTS Approval 1

3961 PULMONARY DISEASES Daliresp 500MCG OR TABS RESPIRATORY AGENTS Approval 1

3952 PEDIATRICS Denavir (penciclovir) ANTIVIRALS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Denavir (penciclovir) ANTIVIRALS Approval 1

3963 FAMILY PRACTICE Denavir (penciclovir) ANTIVIRALS Approval 1

3963 FAMILY PRACTICE Denavir (penciclovir) ANTIVIRALS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 1

3952 EMERGENCY MEDICINE Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 1

3956 FAMILY PRACTICE Depo-Testosterone 200MG/ML IM SOLN ANDROGENS No Response 1

3963 FAMILY PRACTICE Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 3

3963 INTERNAL MEDICINE Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Depo-Testosterone 200MG/ML IM SOLN ANDROGENS No Response 1

3963 NURSE PRACTITIONER, UNSPECIFIED Depo-Testosterone 200MG/ML IM SOLN ANDROGENS Approval 1

3963 UROLOGY Depo-Testosterone 200MG/ML IM SOLN ANDROGENS No Response 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Derma-Smoothe F/S (Brand Only) (fluocinolone) DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Desonate 0.05% EX GEL DERMATOLOGICAL AGENTS Approval 1

3954 GENERAL PRACTICE DEXCOM G6 EACH DEVICES Approval 1

3963 FAMILY PRACTICE DEXCOM G6 EACH DEVICES Approval 1

3963 PEDIATRICS DEXCOM G6 SENSOR DEVICES Denial 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dexcom G6 Sensor DEVICES Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Sensor XX MISC DEVICES Approval 1

3951 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES Approval 1

3952 ENDOCRINOLOGY, DIABETES & METABOLISM Dexcom G6 Sensor XX MISC DEVICES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Sensor XX MISC DEVICES No Response 1

3963 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Dexcom G6 Sensor XX MISC DEVICES Denial 1

3963 ENDOCRINOLOGY, PEDIATRIC Dexcom G6 Sensor XX MISC DEVICES Approval 1

3963 FAMILY PRACTICE Dexcom G6 Sensor XX MISC DEVICES Approval 1

13


3963 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES Approval 1

3963 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES No Response 1

3963 PHYSICIAN, ENDOCRINOLOGY Dexcom G6 Sensor XX MISC DEVICES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Transmitter XX MISC DEVICES Approval 2

3963 FAMILY PRACTICE Dexcom G6 Transmitter XX MISC DEVICES Approval 1

3956 FAMILY PRACTICE Dexilant 60MG OR CPDR GASTROINTESTINAL AGENTS No Response 1

3956 OPHTHALMOLOGY Dexilant 60MG OR CPDR GASTROINTESTINAL AGENTS No Response 1

3956 PSYCHIATRY Dexmethylphenidate HCl 10MG OR TABS CNS STIMULANTS Approval 1

3963 ORTHOPEDIC SURGERY diclofenac 1 % topical gel (VOLTAREN) NON-NARCOTIC ANALGESICS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 4

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 2

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 ANESTHESIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 5

3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 2

3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 NURSE PRACTITIONER, ADULT HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 2

3951 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 PHYSICIAN, GERIATRIC MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3951 PODIATRIST, PRIMARY MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1



3952 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3952 CARDIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1


3952 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3952 NURSE PRACTITIONER, ADULT HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3952 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 2

3952 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3952 PEDIATRICS Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1

3952 PEDIATRICS Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

14


3952 PODIATRIST, UNSPECIFIED Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1




3963 ANESTHESIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 2

3963 EMERGENCY MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 1


3963 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 2

3963 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 4


3963 NEUROLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 3

3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 3

3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 3

3963 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 5

3963 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3963 PAIN MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3963 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Denial 1

3963 RHEUMATOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS Approval 4

3963 RHEUMATOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 4

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 3

3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS No Response 1

3951 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 2

3951 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 3

3951 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 2

3951 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 2

3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 3

3951 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3951 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3951 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3951 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1


3952 ANESTHESIOLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

15





3952 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3952 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3952 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 3


3963 ANESTHESIOLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 2

3963 EMERGENCY MEDICINE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1



3963 GENERAL PRACTICE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3963 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3963 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 4

3963 NEUROLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 4


3963 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3963 PEDIATRICS Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3963 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 2

3963 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3963 PSYCHIATRY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Approval 1

3963 RHEUMATOLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS Denial 1

3956 INTERNAL MEDICINE Dificid (fidaxomicin) ANTI-INFECTIVES Approval 1

3961 INFECTIOUS DISEASES Dificid (fidaxomicin) ANTI-INFECTIVES Approval 1

3961 FAMILY PRACTICE Dificid 200MG OR TABS ANTI-INFECTIVES Approval 1

3951 CARDIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1

3956 CARDIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1

3956 NURSE PRACTITIONER, ACUTE CARE dofetilide CARDIOVASCULAR AGENTS Approval 1

3956 NURSE PRACTITIONER, UNSPECIFIED dofetilide CARDIOVASCULAR AGENTS Approval 1

3956 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1

3961 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Doryx (doxycycline hyclate) ANTI-INFECTIVES Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Doryx 50MG OR TBEC ANTI-INFECTIVES Approval 1

3963 DERMATOLOGY Doxycycline ANTI-INFECTIVES Denial 1

16


3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline 40MG OR CPDR ANTI-INFECTIVES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline 40MG OR CPDR ANTI-INFECTIVES No Response 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Doxycycline 40MG OR CPDR ANTI-INFECTIVES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline Hyclate 100MG OR TBEC ANTI-INFECTIVES Approval 1

3963 DERMATOLOGY Doxycycline Hyclate 150MG OR TBEC ANTI-INFECTIVES Approval 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline Hyclate 200MG OR TBEC ANTI-INFECTIVES Approval 1

3963 ANESTHESIOLOGY Dronabinol ANTINAUSEANTS Denial 1

3963 HEMATOLOGY & ONCOLOGY Dronabinol ANTINAUSEANTS Approval 1

3963 PEDIATRICS Dronabinol ANTINAUSEANTS Denial 1

3963 FAMILY PRACTICE Dronabinol 10MG OR CAPS ANTINAUSEANTS Denial 1

3951 HEMATOLOGY & ONCOLOGY Dronabinol 2.5MG OR CAPS ANTINAUSEANTS Approval 1

3963 INFECTIOUS DISEASES Dronabinol 2.5MG OR CAPS ANTINAUSEANTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Duobrii 0.01-0.045% EX LOTN DERMATOLOGICAL AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Duobrii 0.01-0.045% EX LOTN DERMATOLOGICAL AGENTS Approval 2

3963 DERMATOLOGY Duobrii 0.01-0.045% EX LOTN DERMATOLOGICAL AGENTS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Duobrii 0.01-0.045% EX LOTN DERMATOLOGICAL AGENTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

3951 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1

3951 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2

3952 PRESCRIBER SPECIALTY, UNKNOWN Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

3952 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

3952 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

3952 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1


3954 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 2


3963 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

3963 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1

3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 2

3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1

3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 4

3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2

17


3963 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

3951 DERMATOLOGY Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2

3963 ALLERGY & IMMUNOLOGY Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2

3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

3963 FAMILY PRACTICE Duragesic-75 75MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Ecoza 1% EX FOAM ANTIFUNGALS Approval 1

3951 FAMILY PRACTICE Eletriptan NON-NARCOTIC ANALGESICS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Elidel (pimecrolimus) DERMATOLOGICAL AGENTS Denial 2

3951 DERMATOLOGY Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 3

3963 DERMATOLOGY Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 1

3963 INTERNAL MEDICINE Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 3

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Elidel 1% EX CREA DERMATOLOGICAL AGENTS Approval 1

3956 OBSTETRICS & GYNECOLOGY Eligard 22.5mg HORMONES/HORMONE MODIFIERS Denial 1

3956 OBSTETRICS & GYNECOLOGY Eligard 22.5MG SC KIT HORMONES/HORMONE MODIFIERS No Response 1

3963 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Embeda 20-0.8MG OR CPCR NARCOTIC ANALGESICS Approval 1

3951 ANESTHESIOLOGY Embeda 30-1.2MG OR CPCR NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Emsam (selegiline) ANTIDEPRESSANTS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 2

3951 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1

3951 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 5

3951 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 2



3956 PRESCRIBER SPECIALTY, UNKNOWN Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1

3956 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1


3956 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 1

3956 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1


3961 PRESCRIBER SPECIALTY, UNKNOWN Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 1




18



3963 PRESCRIBER SPECIALTY, UNKNOWN Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 2

3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 1

3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 1

3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1

3963 FAMILY PRACTICE Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 2

3963 NURSE PRACTITIONER, UNSPECIFIED Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response 1


3963 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Epidiolex DERMATOLOGICAL AGENTS No Response 1

3963 NEUROLOGY, PEDIATRIC Epidiolex DERMATOLOGICAL AGENTS Denial 2

3956 DERMATOLOGY Erivedge ANTINEOPLASTICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Esbriet RESPIRATORY AGENTS Denial 1

3956 PULMONARY DISEASES Esbriet RESPIRATORY AGENTS Approval 1

3951 OBSTETRICS & GYNECOLOGY Estradiol 0.1MG/GM VA CREA HORMONES/HORMONE MODIFIERS No Response 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Exelderm 1% EX CREA DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Fabior 0.1% EX FOAM DERMATOLOGICAL AGENTS Approval 1

3963 INTERNAL MEDICINE Fabior 0.1% EX FOAM DERMATOLOGICAL AGENTS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Fabior 0.1% EX FOAM DERMATOLOGICAL AGENTS Approval 1

3956 FAMILY PRACTICE Fentanyl 100 mcg TD Patch NARCOTIC ANALGESICS Approval 1

3951 FAMILY PRACTICE fentaNYL 100MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3951 ANESTHESIOLOGY fentaNYL 12MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN fentaNYL 25MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3956 HEMATOLOGY & ONCOLOGY fentaNYL 25MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3956 FAMILY PRACTICE Fentanyl 50 mcg TD Patch NARCOTIC ANALGESICS Approval 1

3961 ANESTHESIOLOGY Fentanyl 50 mcg TD Patch NARCOTIC ANALGESICS Approval 1

3963 INTERNAL MEDICINE FENTANYL 50MCG/HR DIS NARCOTIC ANALGESICS No Response 1

3952 FAMILY PRACTICE fentaNYL 50MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN fentaNYL 50MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3956 INTERNAL MEDICINE fentaNYL 50MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3963 ANESTHESIOLOGY fentaNYL 50MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1


3963 ORTHOPEDIC SURGERY fentaNYL 50MCG/HR TD PT72 NARCOTIC ANALGESICS Approval 1

3951 ANESTHESIOLOGY Fentanyl 50mcg/hr Transdermal Patch NARCOTIC ANALGESICS Denial 1

3951 INTERNAL MEDICINE Fentanyl 50mcg/hr Transdermal Patch NARCOTIC ANALGESICS Approval 1

3956 PALLIATIVE MEDICINE Fentanyl 75 mcg TD Patch NARCOTIC ANALGESICS Approval 1


19


3952 ANESTHESIOLOGY Fentanyl 75mcg/hr Transdermal Patch NARCOTIC ANALGESICS Approval 1

3952 ANESTHESIOLOGY Fentanyl 75mcg/hr Transdermal Patch NARCOTIC ANALGESICS Denial 1

3963 FAMILY PRACTICE Fluocinonide 0.05% Cream DERMATOLOGICAL AGENTS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS No Response 1

3951 FAMILY PRACTICE Forteo OSTEOPOROSIS AGENTS Approval 1

3951 FAMILY PRACTICE Forteo OSTEOPOROSIS AGENTS No Response 1

3951 INTERNAL MEDICINE Forteo OSTEOPOROSIS AGENTS Approval 1

3951 RHEUMATOLOGY Forteo OSTEOPOROSIS AGENTS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS No Response 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS Approval 1

3963 OBSTETRICS & GYNECOLOGY Forteo OSTEOPOROSIS AGENTS No Response 1

3963 FAMILY PRACTICE Freestyle Continuous Blood Glucose System Sensor DIABETIC SUPPLIES Denial 1

3963 NURSE PRACTITIONER, WOMEN’S HEALTH FREESTYLE LIBRE 10 DAY SENS KIT DIABETIC SUPPLIES Approval 1

3951 FAMILY PRACTICE FreeStyle Libre 14 Day Reader XX DEVI DEVICES Denial 1

3963 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14 Day Reader XX DEVI DEVICES No Response 1

3963 FAMILY PRACTICE FreeStyle Libre 14 Day Reader XX DEVI DEVICES Approval 1

3951 FAMILY PRACTICE FreeStyle Libre 14 Day Sensor XX MISC DEVICES Denial 1

3952 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14 Day Sensor XX MISC DEVICES Approval 1

3952 REGISTERED NURSE, UNSPECIFIED FreeStyle Libre 14 Day Sensor XX MISC DEVICES Denial 1

3963 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14 Day Sensor XX MISC DEVICES Denial 1

3963 FAMILY PRACTICE FreeStyle Libre 14 Day Sensor XX MISC DEVICES Denial 1

3963 INTERNAL MEDICINE FreeStyle Libre 14 Day Sensor XX MISC DEVICES Denial 1

3963 INTERNAL MEDICINE FreeStyle Libre 14 Day Sensor XX MISC DEVICES No Response 1

3952 FAMILY PRACTICE FreeStyle Libre Continuous Blood Glucose Monitoring System DIABETIC SUPPLIES Denial 1

3951 PHYSICIAN, ENDOCRINOLOGY Freestyle Libre Continuous Blood glucose Reader DIABETIC SUPPLIES Denial 1

3952 INTERNAL MEDICINE Freestyle Libre Reader DEVICES Denial 1

3963 FAMILY PRACTICE FreeStyle Libre Reader XX DEVI DEVICES Denial 1

3951 ENDOCRINOLOGY, PEDIATRIC FreeStyle Libre Sensor System XX MISC DEVICES Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Genotropin HORMONES/HORMONE MODIFIERS Approval 1

3952 ENDOCRINOLOGY, PEDIATRIC Genotropin 12MG SC SOLR HORMONES/HORMONE MODIFIERS Denial 1

3956 NEUROLOGY Gilenya MULTIPLE SCLEROSIS Denial 1

3961 NEUROLOGY Gilenya MULTIPLE SCLEROSIS Approval 1

3961 NURSE PRACTITIONER, FAMILY HEALTH glatiramer acetate 20mg MULTIPLE SCLEROSIS Approval 1

3951 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1

3952 PRESCRIBER SPECIALTY, UNKNOWN glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 2


20


3952 NURSE PRACTITIONER, FAMILY HEALTH glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1

3956 FAMILY PRACTICE glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1


3956 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1


3963 PHYSICIAN ASSISTANT, UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1

3961 NURSE PRACTITIONER, FAMILY HEALTH Glatopa MULTIPLE SCLEROSIS No Response 1

3963 NEUROLOGY Glatopa MULTIPLE SCLEROSIS Approval 1

3951 HEMATOLOGY Gleevec ANTINEOPLASTICS No Response 1

3963 HEMATOLOGY & ONCOLOGY Gleevec ANTINEOPLASTICS Approval 1

3963 HEMATOLOGY & ONCOLOGY Gleevec ANTINEOPLASTICS No Response 1

3963 ALLERGY & IMMUNOLOGY Grastek 2800BAU SL SUBL ALLERGENS Approval 1

3963 DERMATOLOGY Halog 0.1% EX OINT DERMATOLOGICAL AGENTS Approval 1

3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Hizentra IMMUNOGLOBULINS Approval 1

3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Hizentra IMMUNOGLOBULINS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Humatrope HORMONES/HORMONE MODIFIERS Approval 2

3951 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE MODIFIERS Approval 1

3951 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE MODIFIERS Denial 1

3952 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE MODIFIERS Denial 1


3961 PEDIATRICS Humatrope HORMONES/HORMONE MODIFIERS Approval 1

3961 PEDIATRICS Humatrope HORMONES/HORMONE MODIFIERS No Response 2


3951 PRESCRIBER SPECIALTY, UNKNOWN Humira IMMUNOSUPPRESSIVES/DMARDS Approval 4

3951 PRESCRIBER SPECIALTY, UNKNOWN Humira IMMUNOSUPPRESSIVES/DMARDS No Response 4

3951 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 4

3951 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1

3951 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1

3951 GASTROENTEROLOGY, PEDIATRIC Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS Approval 2

3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 2

3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 2

3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1



3952 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1


21



3956 PRESCRIBER SPECIALTY, UNKNOWN Humira IMMUNOSUPPRESSIVES/DMARDS Denial 2


3956 DENTIST, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1


3956 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 1

3956 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1

3956 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS No Response 3



3956 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS Approval 2

3956 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS No Response 2

3956 NURSE PRACTITIONER, FAMILY HEALTH Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1

3956 NURSE PRACTITIONER, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1

3956 NURSE PRACTITIONER, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS No Response 2









3961 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1








3963 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 1


3963 GASTROENTEROLOGY, PEDIATRIC Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1

3963 GASTROENTEROLOGY, PEDIATRIC Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1

3963 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS Denial 1

3963 NURSE PRACTITIONER, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS Approval 2

22


3963 NURSE PRACTITIONER, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS No Response 1





3956 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg/0.8 mL subcutaneous syringe kit IMMUNOSUPPRESSIVES/DMARDS Approval 1

3961 RHEUMATOLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1

3956 DERMATOLOGY Humira Pen 40MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1

3963 NURSE PRACTITIONER, UNSPECIFIED Humira Pen-Ps/UV/Adol HS Start 80 MG/0.8ML &40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 3

3956 CARDIOLOGY Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 1

3956 FAMILY PRACTICE Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 2

3956 GENERAL PRACTICE Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 2

3956 HEMATOLOGY & ONCOLOGY Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 1

3956 INTERNAL MEDICINE Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 1

3956 INTERNAL MEDICINE Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Denial 1

3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS No Response 1

3956 FAMILY PRACTICE Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 3

3956 INTERNAL MEDICINE Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 2

3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS No Response 1

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 1

3956 ANESTHESIOLOGY Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS Approval 2

3956 FAMILY PRACTICE Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 3

3956 INTERNAL MEDICINE Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS Approval 1

3956 NEUROLOGICAL SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 1

3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS Approval 1

3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 1

3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS Approval 1

3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 2

3963 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone 10 mg-acetaminophen 325 mg tablet (NORCO 10-325) NARCOTIC ANALGESICS No Response 1

3952 FAMILY PRACTICE HYDROcodone 5 mg-acetaminophen 325 mg tablet (NORCO) NARCOTIC ANALGESICS Approval 1

23


3951 FAMILY PRACTICE HYDROcodone 7.5 mg-acetaminophen 325 mg tablet (NORCO) NARCOTIC ANALGESICS Approval 1

3952 CLINICAL NURSE SPECIALIST, ADULT HEALTH HYDROcodone 7.5 mg-acetaminophen 325 mg tablet (NORCO) NARCOTIC ANALGESICS No Response 1

3963 NEUROLOGICAL SURGERY HYDROcodone 7.5 mg-acetaminophen 325 mg tablet (NORCO) NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen 10-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 2

3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 10-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3951 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1


3956 ANESTHESIOLOGY HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1


3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS No Response 1

3956 GENERAL PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS No Response 2

3956 PHYSICIAN ASSISTANT, UNSPECIFIED HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1






3963 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3963 ORTHOPEDIC SURGERY HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 1

3956 ORTHOPEDIC SURGERY hydrocodone-acetaminophen 5-325 mg tablet NARCOTIC ANALGESICS No Response 1


3951 CLINICAL NURSE SPECIALIST, ACUTE CARE HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1



3956 EMERGENCY MEDICINE HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1


3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS No Response 1

3956 HEMATOLOGY & ONCOLOGY HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1



24


3956 PAIN MEDICINE HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN, ANESTHESIOLOGY, PAIN MANAGEMENT HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1


3963 EMERGENCY MEDICINE HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS Approval 1


3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen 7.5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 1

3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 7.5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 2

3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen 7.5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 2

3951 ANESTHESIOLOGY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3951 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Denial 1

3952 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3956 ANESTHESIOLOGY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 4

3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS No Response 1

3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3956 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS No Response 1

3956 PHYSICIAN, SURGERY, GENERAL HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3963 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2

3951 FAMILY PRACTICE Hydrocodone-APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Hydrocodone-APAP Tab 10-325 mg NARCOTIC ANALGESICS Approval 1

3951 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION / PHYS-IATRY Hydrocodone-APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Hydrocodone-APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3963 INTERNAL MEDICINE Hydrocodone-APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval 1

3963 FAMILY PRACTICE Hydrocodone-APAP Tab 7.5-325 mg NARCOTIC ANALGESICS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN HYDROmorphone HCl 2MG OR TABS NARCOTIC ANALGESICS Approval 1

3956 NURSE PRACTITIONER, UNSPECIFIED Hydromorphone Tab 2 mg NARCOTIC ANALGESICS Approval 1

3956 PHYSICIAN, SURGERY, GENERAL Hydromorphone Tab 2 mg NARCOTIC ANALGESICS Approval 1

3963 ALLERGY & IMMUNOLOGY HyQvia IMMUNOGLOBULINS Approval 1

3963 FAMILY PRACTICE Hysingla ER 30MG OR T24A NARCOTIC ANALGESICS Approval 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS No Response 1

25


3956 HEMATOLOGY Ibrance ANTINEOPLASTICS Approval 1

3956 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Approval 1

3956 MEDICAL ONCOLOGY Ibrance ANTINEOPLASTICS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS No Response 1

3951 HEMATOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2

3951 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2


3952 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Denial 2


3956 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Denial 2

3961 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS No Response 2

3963 HEMATOLOGY imatinib mesylate ANTINEOPLASTICS Denial 2


3963 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS No Response 2

3952 PRESCRIBER SPECIALTY, UNKNOWN Imbruvica ANTINEOPLASTICS Approval 1

3952 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS Approval 1

3952 PHYSICIAN, ONCOLOGY, MEDICAL Imbruvica ANTINEOPLASTICS Approval 1


3956 MEDICAL ONCOLOGY Imbruvica ANTINEOPLASTICS Approval 1




3963 HEMATOLOGY Imbruvica ANTINEOPLASTICS Approval 1

3963 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS No Response 1

3956 MEDICAL ONCOLOGY Imbruvica 140MG OR CAPS ANTINEOPLASTICS No Response 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Increlex HORMONES/HORMONE MODIFIERS No Response 1

3963 PEDIATRICS Increlex HORMONES/HORMONE MODIFIERS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Inlyta ANTINEOPLASTICS Approval 1


3956 NURSE PRACTITIONER, ACUTE CARE Inlyta ANTINEOPLASTICS Approval 1


3951 PRESCRIBER SPECIALTY, UNKNOWN Isotretinoin DERMATOLOGICAL AGENTS Approval 1

3951 PHYSICIAN ASSISTANT, UNSPECIFIED Isotretinoin DERMATOLOGICAL AGENTS Approval 1

3963 DERMATOLOGY Isotretinoin DERMATOLOGICAL AGENTS Approval 1

3954 FAMILY PRACTICE ISOtretinoin 10MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN isotretinoin 20 mg capsule DERMATOLOGICAL AGENTS Approval 1

26


3956 PRESCRIBER SPECIALTY, UNKNOWN ISOtretinoin 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3956 NURSE PRACTITIONER, FAMILY HEALTH ISOtretinoin 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED ISOtretinoin 20MG OR CAPS DERMATOLOGICAL AGENTS Approval 1


3956 DERMATOLOGY ISOtretinoin 30MG OR CAPS DERMATOLOGICAL AGENTS Approval 1


3952 PHYSICIAN ASSISTANT, UNSPECIFIED ISOtretinoin 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1


3963 FAMILY PRACTICE ISOtretinoin 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 1

3963 NURSE PRACTITIONER, FAMILY HEALTH ISOtretinoin 40MG OR CAPS DERMATOLOGICAL AGENTS Approval 3

3952 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3956 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS No Response 2

3956 NURSE PRACTITIONER, FAMILY HEALTH Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3961 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3961 PULMONARY DISEASES Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3963 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS Approval 1

3951 INFECTIOUS DISEASES Itraconazole Capsules ANTIFUNGALS Approval 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole Capsules ANTIFUNGALS Denial 2

3956 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Approval 2

3956 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Denial 2


3956 OTOLARYNGOLOGY Itraconazole Capsules ANTIFUNGALS Denial 1

3956 PODIATRIST, UNSPECIFIED Itraconazole Capsules ANTIFUNGALS Approval 1

3956 PULMONARY DISEASES Itraconazole Capsules ANTIFUNGALS Approval 1

3961 FAMILY MEDICINE Itraconazole Capsules ANTIFUNGALS Approval 1

3961 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Denial 1

3961 NURSE PRACTITIONER, FAMILY HEALTH Itraconazole Capsules ANTIFUNGALS Denial 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole Capsules ANTIFUNGALS Approval 1

3963 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Approval 1


3963 INTERNAL MEDICINE Itraconazole Capsules ANTIFUNGALS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 1

3951 DERMATOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 2

3952 DERMATOPATHOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 1

3952 FAMILY PRACTICE Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 1

3963 PRESCRIBER SPECIALTY, UNKNOWN Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 2

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3963 DERMATOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 2

3963 NURSE PRACTITIONER, FAMILY HEALTH Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 1

3963 PHYSICIAN ASSISTANT, UNSPECIFIED Ivermectin 1% EX CREA ANTIPARASITIC AGENTS Approval 1

3956 INTERNAL MEDICINE Jakafi ANTINEOPLASTICS Approval 1

3963 PHYSICIAN, ONCOLOGY, MEDICAL Jakafi ANTINEOPLASTICS Denial 1

3963 DERMATOLOGY Jublia 10 % topical solution with applicator ANTIFUNGALS No Response 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Jublia 10% EX SOLN ANTIFUNGALS Approval 1

3952 DERMATOLOGY Jublia 10% EX SOLN ANTIFUNGALS Approval 1

3952 FAMILY PRACTICE Jublia 10% EX SOLN ANTIFUNGALS Approval 1


3956 PHYSICIAN ASSISTANT, UNSPECIFIED Jublia 10% EX SOLN ANTIFUNGALS Approval 1




3963 FAMILY PRACTICE Jublia 10% EX SOLN ANTIFUNGALS Approval 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Jynarque HORMONES/HORMONE MODIFIERS Approval 1

3951 NEPHROLOGY / RENAL MEDICINE Jynarque HORMONES/HORMONE MODIFIERS Denial 1

3951 PRESCRIBER SPECIALTY, UNKNOWN Kerydin (tavaborole topical solution) ANTIFUNGALS Denial 1

3963 DERMATOLOGY Kerydin (tavaborole topical solution) ANTIFUNGALS Denial 2

3963 PRESCRIBER SPECIALTY, UNKNOWN Kerydin 5% EX SOLN ANTIFUNGALS Approval 1

3963 DERMATOLOGY Kerydin 5% EX SOLN ANTIFUNGALS Approval 2

3963 DERMATOLOGY Kerydin 5% EX SOLN ANTIFUNGALS No Response 3

3963 PODIATRIST, SURGERY, FOOT & ANKLE Kerydin 5% EX SOLN ANTIFUNGALS Approval 1

3956 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1

3963 INTERNAL MEDICINE Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1

3963 INTERNAL MEDICINE Kevzara IMMUNOSUPPRESSIVES/DMARDS No Response 1

3963 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 3

3956 HEMATOLOGY & ONCOLOGY Kisqali ANTINEOPLASTICS Approval 1

3963 PULMONOLOGY, PEDIATRIC Kitabis Pak ANTI-INFECTIVES Approval 1

3956 PHYSICIAN ASSISTANT, UNSPECIFIED Kuvan METABOLIC AGENTS Approval 1

3956 INTERNAL MEDICINE Lenvima ANTINEOPLASTICS Denial 1

3963 ONCOLOGY, GYNECOLOGIC Lenvima ANTINEOPLASTICS Denial 2

3951 FAMILY PRACTICE Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS Denial 1

3952 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS Denial 5

3952 PAIN MEDICINE Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS Approval 1

3952 PSYCHIATRY Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS Denial 1

3956 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS Approval 1

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3956 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH NON-NARCOTIC ANALGES

Physician Specialty Overview by Prior Authorization ......3963 HEMATOLOGY Aranesp HEMATINICS & BLOOD...

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