№ lp_2_2_05176
Comprehensive prior authorization criteria masterfile listing medications and therapeutic agents covered under a prescription drug program as of July 1, 2022.
Program Name: The Evidence-Based Prescription Drug Program
Document Title: Quarterly PA Criteria Masterfile
Version: July 2022 update
Published Date: July 1, 2022
Document Type: Prior Authorization Criteria Masterfile
Subject: Prescription Drug Prior Authorization Criteria
Contact Office: EBRx Prior Authorization Call Center
Phone: (866) 564-8258
Fax: (877) 540-9036
Content: Table of Contents listing covered medications and therapeutic agents
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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