PERM AUDIT INFORMATION

Pharmacy Help Desk: 1-877-209-1264, Provider PA Help Desk: 1-877-207-1126

Preferred Drug List

File Description Date
PDL Effective 8-19-15 592.25 KB 2015/08/19
PDL Effective 7-1-5 564.52 KB 2015/07/02
PDL Effective 6-1-15 564.09 KB 2015/06/23
PDL Effective 4-22-15 563.45 KB 2015/04/22
PDL Effective 2-25-15 561.76 KB 2015/02/25
PDL Effective 1-1-15 630.98 KB 2015/01/01
PDL Effective 10-15-14 325.84 KB 2014/10/15
PDL Effective 8-6-14 444.75 KB 2014/08/06
PDL Effective 7-1-14 410.34 KB 2014/07/01
PDL Effective 5-22-2014 423.79 KB 2014/05/22
PDL Effective 3-5-2014 410.14 KB 2014/03/05
PDL Effective 01-08-2014 425.75 KB 2014/01/08
PDL Effective 01-01-2014 480.36 KB 2013/12/30
PDL Effective 11-01-2013 612.31 KB 2013/11/07
PDL Effective 9-10-2013 245.08 KB 2013/09/12
PDL Effective 5-28-2013 645.46 KB 2013/05/28
PDL Effective 1-1-2013 490.24 KB 2013/01/03
PDL Effective 8-1-2012 142.54 KB 2012/08/30
PDL Effective 5-2-2012 145.72 KB 2012/05/14
PDL Effective 4-18-2012 195.88 KB 2012/04/25
PDL Effective 01-01-12 178.23 KB 2012/01/04

Prior Authorization Process

File Description Date
Website PA Process 167.99 KB 2010/08/06

Additional PDL News & Info

File Description Date
Additional Therapeutic Criteria Effective June 2015 52.72 KB 2013/10/16
Dosage Limitation Chart (June 2011) 62.84 KB 2011/06/15

Archive Files