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Forms & Documents - New Hampshire
Forms and Documents
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CMS Tamper Resistant Prescription Pad Implementation
0.01 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_FAQ
0.03 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_Pharmacist Fact Sheet
0.04 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_Pharmacist Info
0.03 MB
Mar 10' 2023
CMS TRPP State Medicaid Director Letter
0.08 MB
Mar 10' 2023
DUR Agenda 03.20.2017
0.3 MB
Mar 13' 2023
DUR Agenda 05.12.2015
0.04 MB
Mar 13' 2023
DUR Agenda 05.20.2014
0.06 MB
Mar 13' 2023
DUR Agenda 05.31.2016
0.09 MB
Mar 13' 2023
DUR Agenda 10.11.2016
0.09 MB
Mar 13' 2023
DUR Agenda 10.24.2017
0.44 MB
Mar 13' 2023
Notification 01.09.2015 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 01.10.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 04.02.2013 Change in TPL Field Length
0.03 MB
Mar 13' 2023
Notification 05.17.2012 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 05.26.2017 Updated Fiscal Impact Regarding Outpatient Drug Rule
0.01 MB
Mar 13' 2023
Notification 06.16.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.18 MB
Mar 13' 2023
Notification 07.03.2014 Changes to Copay
0.03 MB
Mar 13' 2023
Notification 07.20.2016 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 07.25.2012 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 08.01.2014 PDL-Clinical PA Updates-Web Portal Info-Email
0.13 MB
Mar 13' 2023
Notification 08.04.2013 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 08.22.2012 Diabetic Supply Program Update
0.03 MB
Mar 13' 2023
Notification 08.24.2015 PDL Transition
0.02 MB
Mar 13' 2023
Notification 08.24.2015 PDL-Clinical PA Updates-Web Portal Info-Email
0.04 MB
Mar 13' 2023
Notification 10.08.2017 Emergency Drug Coverage Reminder
0.1 MB
Mar 13' 2023
Notification 10.30.2014 NHHPP Reinstatement of Co-Pays
0.05 MB
Mar 13' 2023
Notification 12.06.2012 Benzodiazepines and Barbiturates in Dual Eligibles
0.03 MB
Mar 13' 2023
Notification 12.07.2012 Diabetic Supply Program
0.04 MB
Mar 13' 2023
Notification 12.15.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.17 MB
Mar 13' 2023
Adenosine Triphosphate-Citrate Lyase Criteria
0.17 MB
Mar 10' 2023
Allergen Extract Criteria
0.17 MB
Mar 10' 2023
Antifungal for Onychomycosis Criteria
0.27 MB
Mar 10' 2023
Asthma-Allergy Immunomodulator Criteria
0.26 MB
Mar 13' 2023
Bowel Disorders.GI Motility, Chronic Criteria
0.24 MB
Mar 13' 2023
BPH Criteria
0.17 MB
Mar 10' 2023
Brand Name Multisource Drug Criteria
0.14 MB
Mar 10' 2023
Buprenorphine-Naloxone and Buprenorphine (Oral) Criteria
0.19 MB
Mar 13' 2023
Carisoprodol and Combination Criteria
0.15 MB
Mar 10' 2023
CGRP Inhibitor Criteria
0.19 MB
Mar 10' 2023
CNS Stimulants (ADHD.ADD) Criteria
0.25 MB
Mar 13' 2023
Codeine for Pediatric Use Criteria
0.15 MB
Mar 10' 2023
Convenience Kits Criteria
0.14 MB
Mar 10' 2023
Duchenne Muscular Dystrophy Agents Criteria
0.2 MB
Mar 10' 2023
Duloxetine Criteria
0.27 MB
Mar 10' 2023
Dupixent Criteria
0.18 MB
Mar 10' 2023
Fibromyalgia Criteria
0.15 MB
Mar 10' 2023
Hematopoietic Agent Criteria
0.18 MB
Mar 10' 2023
Hepatitis C Criteria
0.37 MB
Mar 10' 2023
Hetlioz Criteria
0.18 MB
Mar 10' 2023
Horizant Criteria
0.14 MB
Mar 10' 2023
Human Growth Hormones Criteria
0.24 MB
Mar 10' 2023
Hyaluronic Acid Derivatives Injection Criteria
0.18 MB
Mar 10' 2023
Inhaled Insulin Criteria
0.17 MB
Mar 10' 2023
Juxtapid Criteria
0.15 MB
Mar 10' 2023
Long-acting Opioid Analgesic Criteria
0.17 MB
Mar 10' 2023
Methadone Criteria
0.17 MB
Mar 10' 2023
Monoclonal Antibody for Alzheimer's Criteria
0.19 MB
Mar 10' 2023
Morphine Milligram Equivalent (MME) Criteria
0.15 MB
Mar 10' 2023
Movement Disorders Criteria
0.21 MB
Mar 10' 2023
New Drug Product Criteria
0.15 MB
Mar 10' 2023
Oral Isotretinoin Criteria
0.15 MB
Mar 10' 2023
PCSK9 Criteria
0.18 MB
Mar 10' 2023
Pregabalin Criteria
0.16 MB
Mar 10' 2023
Psychoactive Meds for Children under 5 Criteria
0.14 MB
Mar 10' 2023
Psychotropic Meds Duplicate Therapy Peds 6 and above Criteria
0.17 MB
Mar 10' 2023
Pulmonary Arterial Hypertension PDE-5 Criteria
0.18 MB
Mar 10' 2023
Rho Kinase Inhibitor Criteria
0.15 MB
Mar 10' 2023
Second-Line Antifungal Criteria
0.2 MB
Mar 10' 2023
Short-Acting Fentanyl Criteria
0.16 MB
Mar 10' 2023
Skin Disorders Criteria
0.26 MB
Mar 10' 2023
Skysona Criteria
0.17 MB
Mar 10' 2023
Spinal Muscular Atrophy Criteria
0.23 MB
Mar 10' 2023
Spravato Criteria
0.19 MB
Mar 10' 2023
Stromectol Criteria
0.14 MB
Mar 10' 2023
Symlin Criteria
0.15 MB
Mar 10' 2023
Synagis Criteria
0.16 MB
Mar 10' 2023
Systemic Immunomodulator Criteria
0.27 MB
Mar 10' 2023
Verquvo Criteria
0.16 MB
Mar 10' 2023
Vuity Criteria
0.15 MB
Mar 10' 2023
Weight Management Criteria
0.2 MB
Mar 20' 2023
Zynteglo Criteria
0.19 MB
Mar 10' 2023
Agenda 03.12.2019
0.14 MB
Mar 13' 2023
Agenda 05.03.2018
0.31 MB
Mar 13' 2023
Agenda 06.02.2022
0.27 MB
Mar 13' 2023
Agenda 06.08.2021
0.12 MB
Mar 13' 2023
Agenda 06.19.2023
0.14 MB
May 17' 2023
Agenda 06.30.2020
0.14 MB
Mar 13' 2023
Agenda 09.27.2018
0.14 MB
Mar 13' 2023
Agenda 10.28.2019
0.14 MB
Mar 13' 2023
Agenda 12.02.2021
0.14 MB
Mar 13' 2023
Agenda 12.13.2022
0.14 MB
Mar 13' 2023
Agenda 12.15.2020
0.14 MB
Mar 13' 2023
Minutes 06.02.2022
0.27 MB
Mar 13' 2023
Minutes 12.02.2021
0.21 MB
Mar 13' 2023
ZOOM Webinar Registration 06.19.2023
0.14 MB
May 17' 2023
Adenosine Triphosphate-Citrate Lyase PA Form
1.75 MB
Mar 10' 2023
Allergen Extract PA Form
1.77 MB
Mar 10' 2023
Anti-Fungal Medication for Onychomycosis PA Form
1.71 MB
Mar 10' 2023
Asthma-Allergy Immunomodulator PA Form
0.98 MB
Mar 13' 2023
Bowel Disorders.GI Motility, Chronic PA Form
1.75 MB
Mar 13' 2023
BPH PA Form
0.95 MB
Mar 10' 2023
Brand Name Multisource Drug PA Form
1.72 MB
Mar 10' 2023
Buprenorphine-Naloxone and Buprenorphine (Oral) PA Form
1.94 MB
Mar 13' 2023
Carisoprodol and Combination PA Form
1.7 MB
Mar 10' 2023
CGRP Inhibitor PA Form
1.04 MB
Mar 10' 2023
CNS Stimulants (ADHD.ADD) PA Form
1.52 MB
Mar 13' 2023
Codeine for Pediatric Use PA Form
1.73 MB
Mar 10' 2023
Convenience Kits PA Form
1.76 MB
Mar 10' 2023
Duchenne Muscular Dystrophy Agents PA Form
0.98 MB
Mar 10' 2023
Duloxetine PA Form
1.77 MB
Mar 10' 2023
Dupixent PA Form
2.14 MB
Mar 10' 2023
Fibromyalgia PA Form
1.7 MB
Mar 10' 2023
Hepatitis C PA Form
0.98 MB
Mar 10' 2023
Hetlioz PA Form
1.72 MB
Mar 10' 2023
Horizant PA Form
1.74 MB
Mar 10' 2023
Human Growth Hormones PA Form
1.75 MB
Mar 10' 2023
Hyaluronic Acid Derivatives Injection PA Form
0.99 MB
Mar 10' 2023
Inhaled Insulin PA Form
1.72 MB
Mar 10' 2023
Juxtapid PA Form
0.98 MB
Mar 10' 2023
Long-acting Opioid Analgesic PA Form
1.76 MB
Mar 10' 2023
Methadone PA Form
1.75 MB
Mar 10' 2023
Monoclonal Antibody for Alzheimer's PA Form
1.01 MB
Mar 10' 2023
Morphine Milligram Equivalent (MME) PA Form
1.74 MB
Mar 10' 2023
Movement Disorders PA Form
1.73 MB
Mar 10' 2023
New Drug Product PA Form
1.7 MB
Mar 10' 2023
Non-Preferred Drug PA Form
1.75 MB
Mar 10' 2023
Oral Isotretinoin PA Form
1.72 MB
Mar 10' 2023
PCSK9 PA Form
1.72 MB
Mar 10' 2023
Pregabalin PA Form
1.76 MB
Mar 10' 2023
Psychoactive Meds for Children under 5 Criteria PA Form
1.71 MB
Mar 10' 2023
Psychotropic Meds Duplicate Therapy Peds 6 and above PA Form
1.72 MB
Mar 10' 2023
Pulmonary Arterial Hypertension PDE-5 PA Form
1.72 MB
Mar 10' 2023
Rho Kinase Inhibitor PA Form
1.68 MB
Mar 10' 2023
Second-Line Antifungal PA Form
0.97 MB
Mar 10' 2023
Short-Acting Fentanyl PA Form
1.01 MB
Mar 10' 2023
Skin Disorders PA Form
1.87 MB
Mar 10' 2023
Skysona PA Form
1.78 MB
Mar 10' 2023
Spinal Muscular Atrophy PA Form
1.81 MB
Mar 10' 2023
Spravato PA Form
1.01 MB
Mar 10' 2023
Stromectol PA Form
1.67 MB
Mar 10' 2023
Symlin PA Form
1.73 MB
Mar 10' 2023
Synagis PA Form
1.74 MB
Mar 10' 2023
Systemic Immunomodulators PA Form
1.77 MB
Mar 10' 2023
Verquvo PA Form
0.96 MB
Mar 10' 2023
Vuity PA Form
0.95 MB
Mar 10' 2023
Weight Management PA Form
2.25 MB
Mar 10' 2023
Zynteglo PA Form
1.78 MB
Mar 10' 2023
COVID-19 Testing and Treatment Group Coverage Ending
0.2 MB
Mar 07' 2023
New Hampshire Medicaid Standing Orders OTC COVID Test Kits and Naloxone
0.27 MB
Mar 03' 2023
Notification 01.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 01.12.2021 Pharmacist Provider Enrollment
0.19 MB
Mar 13' 2023
Notification 01.21.2022 At-Home OTC COVID-19 Test Kits
0.24 MB
Mar 13' 2023
Notification 02.01.2022 Clinical PA Updates-Web Portal Info-Email
0.07 MB
Mar 13' 2023
Notification 02.01.2023 Clinical PA Updates-Web Portal Info-Email
0.13 MB
Mar 13' 2023
Notification 03.12.2021 COVID-19 POS Billing Guidance update
0.15 MB
Mar 13' 2023
Notification 03.12.2021 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 03.15.2023 Pharmacist Provided Medical Services
0.19 MB
Mar 20' 2023
Notification 03.16.2020 PDL-Clinical PA Updates-Web Portal Info-Email
0.08 MB
Mar 13' 2023
Notification 03.28.2023 Standing Orders OTC COVID Test Kits
0.19 MB
Mar 28' 2023
Notification 04.01.2021 COVID-19 POS Billing Guidance update
0.22 MB
Mar 13' 2023
Notification 04.13.2023 Makena Withdrawal
0.07 MB
Apr 14' 2023
Notification 04.14.2022 At-Home OTC COVID-19 Test Kits
0.27 MB
Mar 13' 2023
Notification 04.22.2022 Diabetic Supply Program
0.15 MB
Mar 13' 2023
Notification 05.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 06.01.2023 July PDL update
0.19 MB
Jun 01' 2023
Notification 06.14.2019 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 07.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 07.06.2021 Non-Enrolled Prescriber Edit
0.2 MB
Mar 13' 2023
Notification 07.30.2019 340B Drug Discount Program_Effective 09.01.2019
0.4 MB
Mar 13' 2023
Notification 08.01.2019 PDL and Changes to Pharmacy Carve Out
0.46 MB
Mar 13' 2023
Notification 08.01.2022 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 08.21.2018 Diabetic Supply Program
0.11 MB
Mar 13' 2023
Notification 09.01.2020 PDL-Clinical PA Updates-Web Portal Info-Email
0.04 MB
Mar 13' 2023
Notification 09.01.2021 COVID-19 POS Billing Guidance
0.22 MB
Mar 13' 2023
Notification 09.07.2021 Clinical PA Updates-Web Portal Info-Email
0.15 MB
Mar 13' 2023
Notification 10.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 10.01.2021 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 10.01.2022 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 11.04.2021 Pediatric Influenza Vaccines through POS
0.15 MB
Mar 13' 2023
Notification 11.05.2020 340B Discount Program Effective_1.1.2021
0.43 MB
Mar 13' 2023
Notification 11.28.2018 PDL-Clinical PA Updates-Web Portal Info-Email
0.15 MB
Mar 13' 2023
Notification 12.01.2021 Clinical PA Updates-Web Portal Info-Email
0.17 MB
Mar 13' 2023
Notification 12.05.2018 Diabetic Supply Program
0.13 MB
Mar 13' 2023
Notification 12.10.2020 Prescriber Soft Edit
0.17 MB
Mar 13' 2023
Notification 12.23.2020 COVID-19 POS Billing Guidance
0.21 MB
Mar 13' 2023
Notification 12.31.2020 COVID-19 Billing Guidance update
0.21 MB
Mar 13' 2023
CMS Rebate Participating Manufacturers
0.25 MB
Mar 10' 2023
Diabetic Supply Covered Items List - Effective 10.1.2022
0.15 MB
Apr 25' 2023
Dose Optimization Program
0.01 MB
Mar 10' 2023
MAC Price Research Request Form
0.88 MB
Mar 10' 2023
Maintenance Medications
0.25 MB
Mar 10' 2023
Non-Legend Drug List
0.27 MB
May 12' 2023
Payer Specification
0.9 MB
Mar 10' 2023
Pharmacy Provider Manual - Revised 1.7.2022
0.98 MB
Mar 13' 2023
Preferred Drug List - Effective 9.1.2022
1 MB
Apr 25' 2023
Quantity Limit Program
0.23 MB
Mar 10' 2023
Third Party Liability Other Payer ID Codes
0.15 MB
Mar 10' 2023
Trading Partners FTP Instructions
0.44 MB
Mar 10' 2023
Dose Optimization Program
0.01 MB
Mar 10' 2023
Maintenance Medications
0.25 MB
Mar 10' 2023
Non-Legend Drug List
0.27 MB
May 12' 2023
Preferred Drug List - Effective 9.1.2022
1 MB
Apr 25' 2023
Quantity Limit Program
0.23 MB
Mar 10' 2023
Drug Coverage Lookup User Guide
1.13 MB
Mar 10' 2023
Multi-Ingredient Compound Reference
0.03 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Implementation
0.01 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_FAQ
0.03 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_Pharmacist Fact Sheet
0.04 MB
Mar 10' 2023
CMS Tamper Resistant Prescription Pad Law_Pharmacist Info
0.03 MB
Mar 10' 2023
CMS TRPP State Medicaid Director Letter
0.08 MB
Mar 10' 2023
DUR Agenda 03.20.2017
0.3 MB
Mar 13' 2023
DUR Agenda 05.12.2015
0.04 MB
Mar 13' 2023
DUR Agenda 05.20.2014
0.06 MB
Mar 13' 2023
DUR Agenda 05.31.2016
0.09 MB
Mar 13' 2023
DUR Agenda 10.11.2016
0.09 MB
Mar 13' 2023
DUR Agenda 10.24.2017
0.44 MB
Mar 13' 2023
Notification 01.09.2015 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 01.10.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 04.02.2013 Change in TPL Field Length
0.03 MB
Mar 13' 2023
Notification 05.17.2012 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 05.26.2017 Updated Fiscal Impact Regarding Outpatient Drug Rule
0.01 MB
Mar 13' 2023
Notification 06.16.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.18 MB
Mar 13' 2023
Notification 07.03.2014 Changes to Copay
0.03 MB
Mar 13' 2023
Notification 07.20.2016 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 07.25.2012 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 08.01.2014 PDL-Clinical PA Updates-Web Portal Info-Email
0.13 MB
Mar 13' 2023
Notification 08.04.2013 PDL-Clinical PA Updates-Web Portal Info-Email
0.03 MB
Mar 13' 2023
Notification 08.22.2012 Diabetic Supply Program Update
0.03 MB
Mar 13' 2023
Notification 08.24.2015 PDL Transition
0.02 MB
Mar 13' 2023
Notification 08.24.2015 PDL-Clinical PA Updates-Web Portal Info-Email
0.04 MB
Mar 13' 2023
Notification 10.08.2017 Emergency Drug Coverage Reminder
0.1 MB
Mar 13' 2023
Notification 10.30.2014 NHHPP Reinstatement of Co-Pays
0.05 MB
Mar 13' 2023
Notification 12.06.2012 Benzodiazepines and Barbiturates in Dual Eligibles
0.03 MB
Mar 13' 2023
Notification 12.07.2012 Diabetic Supply Program
0.04 MB
Mar 13' 2023
Notification 12.15.2017 PDL-Clinical PA Updates-Web Portal Info-Email
0.17 MB
Mar 13' 2023
Adenosine Triphosphate-Citrate Lyase Criteria
0.17 MB
Mar 10' 2023
Allergen Extract Criteria
0.17 MB
Mar 10' 2023
Antifungal for Onychomycosis Criteria
0.27 MB
Mar 10' 2023
Asthma-Allergy Immunomodulator Criteria
0.26 MB
Mar 13' 2023
Bowel Disorders.GI Motility, Chronic Criteria
0.24 MB
Mar 13' 2023
BPH Criteria
0.17 MB
Mar 10' 2023
Brand Name Multisource Drug Criteria
0.14 MB
Mar 10' 2023
Buprenorphine-Naloxone and Buprenorphine (Oral) Criteria
0.19 MB
Mar 13' 2023
Carisoprodol and Combination Criteria
0.15 MB
Mar 10' 2023
CGRP Inhibitor Criteria
0.19 MB
Mar 10' 2023
CNS Stimulants (ADHD.ADD) Criteria
0.25 MB
Mar 13' 2023
Codeine for Pediatric Use Criteria
0.15 MB
Mar 10' 2023
Convenience Kits Criteria
0.14 MB
Mar 10' 2023
Duchenne Muscular Dystrophy Agents Criteria
0.2 MB
Mar 10' 2023
Duloxetine Criteria
0.27 MB
Mar 10' 2023
Dupixent Criteria
0.18 MB
Mar 10' 2023
Fibromyalgia Criteria
0.15 MB
Mar 10' 2023
Hematopoietic Agent Criteria
0.18 MB
Mar 10' 2023
Hepatitis C Criteria
0.37 MB
Mar 10' 2023
Hetlioz Criteria
0.18 MB
Mar 10' 2023
Horizant Criteria
0.14 MB
Mar 10' 2023
Human Growth Hormones Criteria
0.24 MB
Mar 10' 2023
Hyaluronic Acid Derivatives Injection Criteria
0.18 MB
Mar 10' 2023
Inhaled Insulin Criteria
0.17 MB
Mar 10' 2023
Juxtapid Criteria
0.15 MB
Mar 10' 2023
Long-acting Opioid Analgesic Criteria
0.17 MB
Mar 10' 2023
Methadone Criteria
0.17 MB
Mar 10' 2023
Monoclonal Antibody for Alzheimer's Criteria
0.19 MB
Mar 10' 2023
Morphine Milligram Equivalent (MME) Criteria
0.15 MB
Mar 10' 2023
Movement Disorders Criteria
0.21 MB
Mar 10' 2023
New Drug Product Criteria
0.15 MB
Mar 10' 2023
Oral Isotretinoin Criteria
0.15 MB
Mar 10' 2023
PCSK9 Criteria
0.18 MB
Mar 10' 2023
Pregabalin Criteria
0.16 MB
Mar 10' 2023
Psychoactive Meds for Children under 5 Criteria
0.14 MB
Mar 10' 2023
Psychotropic Meds Duplicate Therapy Peds 6 and above Criteria
0.17 MB
Mar 10' 2023
Pulmonary Arterial Hypertension PDE-5 Criteria
0.18 MB
Mar 10' 2023
Rho Kinase Inhibitor Criteria
0.15 MB
Mar 10' 2023
Second-Line Antifungal Criteria
0.2 MB
Mar 10' 2023
Short-Acting Fentanyl Criteria
0.16 MB
Mar 10' 2023
Skin Disorders Criteria
0.26 MB
Mar 10' 2023
Skysona Criteria
0.17 MB
Mar 10' 2023
Spinal Muscular Atrophy Criteria
0.23 MB
Mar 10' 2023
Spravato Criteria
0.19 MB
Mar 10' 2023
Stromectol Criteria
0.14 MB
Mar 10' 2023
Symlin Criteria
0.15 MB
Mar 10' 2023
Synagis Criteria
0.16 MB
Mar 10' 2023
Systemic Immunomodulator Criteria
0.27 MB
Mar 10' 2023
Verquvo Criteria
0.16 MB
Mar 10' 2023
Vuity Criteria
0.15 MB
Mar 10' 2023
Weight Management Criteria
0.2 MB
Mar 20' 2023
Zynteglo Criteria
0.19 MB
Mar 10' 2023
Agenda 03.12.2019
0.14 MB
Mar 13' 2023
Agenda 05.03.2018
0.31 MB
Mar 13' 2023
Agenda 06.02.2022
0.27 MB
Mar 13' 2023
Agenda 06.08.2021
0.12 MB
Mar 13' 2023
Agenda 06.19.2023
0.14 MB
May 17' 2023
Agenda 06.30.2020
0.14 MB
Mar 13' 2023
Agenda 09.27.2018
0.14 MB
Mar 13' 2023
Agenda 10.28.2019
0.14 MB
Mar 13' 2023
Agenda 12.02.2021
0.14 MB
Mar 13' 2023
Agenda 12.13.2022
0.14 MB
Mar 13' 2023
Agenda 12.15.2020
0.14 MB
Mar 13' 2023
Minutes 06.02.2022
0.27 MB
Mar 13' 2023
Minutes 12.02.2021
0.21 MB
Mar 13' 2023
ZOOM Webinar Registration 06.19.2023
0.14 MB
May 17' 2023
Adenosine Triphosphate-Citrate Lyase PA Form
1.75 MB
Mar 10' 2023
Allergen Extract PA Form
1.77 MB
Mar 10' 2023
Anti-Fungal Medication for Onychomycosis PA Form
1.71 MB
Mar 10' 2023
Asthma-Allergy Immunomodulator PA Form
0.98 MB
Mar 13' 2023
Bowel Disorders.GI Motility, Chronic PA Form
1.75 MB
Mar 13' 2023
BPH PA Form
0.95 MB
Mar 10' 2023
Brand Name Multisource Drug PA Form
1.72 MB
Mar 10' 2023
Buprenorphine-Naloxone and Buprenorphine (Oral) PA Form
1.94 MB
Mar 13' 2023
Carisoprodol and Combination PA Form
1.7 MB
Mar 10' 2023
CGRP Inhibitor PA Form
1.04 MB
Mar 10' 2023
CNS Stimulants (ADHD.ADD) PA Form
1.52 MB
Mar 13' 2023
Codeine for Pediatric Use PA Form
1.73 MB
Mar 10' 2023
Convenience Kits PA Form
1.76 MB
Mar 10' 2023
Duchenne Muscular Dystrophy Agents PA Form
0.98 MB
Mar 10' 2023
Duloxetine PA Form
1.77 MB
Mar 10' 2023
Dupixent PA Form
2.14 MB
Mar 10' 2023
Fibromyalgia PA Form
1.7 MB
Mar 10' 2023
Hepatitis C PA Form
0.98 MB
Mar 10' 2023
Hetlioz PA Form
1.72 MB
Mar 10' 2023
Horizant PA Form
1.74 MB
Mar 10' 2023
Human Growth Hormones PA Form
1.75 MB
Mar 10' 2023
Hyaluronic Acid Derivatives Injection PA Form
0.99 MB
Mar 10' 2023
Inhaled Insulin PA Form
1.72 MB
Mar 10' 2023
Juxtapid PA Form
0.98 MB
Mar 10' 2023
Long-acting Opioid Analgesic PA Form
1.76 MB
Mar 10' 2023
Methadone PA Form
1.75 MB
Mar 10' 2023
Monoclonal Antibody for Alzheimer's PA Form
1.01 MB
Mar 10' 2023
Morphine Milligram Equivalent (MME) PA Form
1.74 MB
Mar 10' 2023
Movement Disorders PA Form
1.73 MB
Mar 10' 2023
New Drug Product PA Form
1.7 MB
Mar 10' 2023
Non-Preferred Drug PA Form
1.75 MB
Mar 10' 2023
Oral Isotretinoin PA Form
1.72 MB
Mar 10' 2023
PCSK9 PA Form
1.72 MB
Mar 10' 2023
Pregabalin PA Form
1.76 MB
Mar 10' 2023
Psychoactive Meds for Children under 5 Criteria PA Form
1.71 MB
Mar 10' 2023
Psychotropic Meds Duplicate Therapy Peds 6 and above PA Form
1.72 MB
Mar 10' 2023
Pulmonary Arterial Hypertension PDE-5 PA Form
1.72 MB
Mar 10' 2023
Rho Kinase Inhibitor PA Form
1.68 MB
Mar 10' 2023
Second-Line Antifungal PA Form
0.97 MB
Mar 10' 2023
Short-Acting Fentanyl PA Form
1.01 MB
Mar 10' 2023
Skin Disorders PA Form
1.87 MB
Mar 10' 2023
Skysona PA Form
1.78 MB
Mar 10' 2023
Spinal Muscular Atrophy PA Form
1.81 MB
Mar 10' 2023
Spravato PA Form
1.01 MB
Mar 10' 2023
Stromectol PA Form
1.67 MB
Mar 10' 2023
Symlin PA Form
1.73 MB
Mar 10' 2023
Synagis PA Form
1.74 MB
Mar 10' 2023
Systemic Immunomodulators PA Form
1.77 MB
Mar 10' 2023
Verquvo PA Form
0.96 MB
Mar 10' 2023
Vuity PA Form
0.95 MB
Mar 10' 2023
Weight Management PA Form
2.25 MB
Mar 10' 2023
Zynteglo PA Form
1.78 MB
Mar 10' 2023
COVID-19 Testing and Treatment Group Coverage Ending
0.2 MB
Mar 07' 2023
New Hampshire Medicaid Standing Orders OTC COVID Test Kits and Naloxone
0.27 MB
Mar 03' 2023
Notification 01.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 01.12.2021 Pharmacist Provider Enrollment
0.19 MB
Mar 13' 2023
Notification 01.21.2022 At-Home OTC COVID-19 Test Kits
0.24 MB
Mar 13' 2023
Notification 02.01.2022 Clinical PA Updates-Web Portal Info-Email
0.07 MB
Mar 13' 2023
Notification 02.01.2023 Clinical PA Updates-Web Portal Info-Email
0.13 MB
Mar 13' 2023
Notification 03.12.2021 COVID-19 POS Billing Guidance update
0.15 MB
Mar 13' 2023
Notification 03.12.2021 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 03.15.2023 Pharmacist Provided Medical Services
0.19 MB
Mar 20' 2023
Notification 03.16.2020 PDL-Clinical PA Updates-Web Portal Info-Email
0.08 MB
Mar 13' 2023
Notification 03.28.2023 Standing Orders OTC COVID Test Kits
0.19 MB
Mar 28' 2023
Notification 04.01.2021 COVID-19 POS Billing Guidance update
0.22 MB
Mar 13' 2023
Notification 04.13.2023 Makena Withdrawal
0.07 MB
Apr 14' 2023
Notification 04.14.2022 At-Home OTC COVID-19 Test Kits
0.27 MB
Mar 13' 2023
Notification 04.22.2022 Diabetic Supply Program
0.15 MB
Mar 13' 2023
Notification 05.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 06.01.2023 July PDL update
0.19 MB
Jun 01' 2023
Notification 06.14.2019 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 07.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 07.06.2021 Non-Enrolled Prescriber Edit
0.2 MB
Mar 13' 2023
Notification 07.30.2019 340B Drug Discount Program_Effective 09.01.2019
0.4 MB
Mar 13' 2023
Notification 08.01.2019 PDL and Changes to Pharmacy Carve Out
0.46 MB
Mar 13' 2023
Notification 08.01.2022 PDL-Clinical PA Updates-Web Portal Info-Email
0.16 MB
Mar 13' 2023
Notification 08.21.2018 Diabetic Supply Program
0.11 MB
Mar 13' 2023
Notification 09.01.2020 PDL-Clinical PA Updates-Web Portal Info-Email
0.04 MB
Mar 13' 2023
Notification 09.01.2021 COVID-19 POS Billing Guidance
0.22 MB
Mar 13' 2023
Notification 09.07.2021 Clinical PA Updates-Web Portal Info-Email
0.15 MB
Mar 13' 2023
Notification 10.01.2019 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 10.01.2021 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 10.01.2022 Diabetic Supply Program
0.14 MB
Mar 13' 2023
Notification 11.04.2021 Pediatric Influenza Vaccines through POS
0.15 MB
Mar 13' 2023
Notification 11.05.2020 340B Discount Program Effective_1.1.2021
0.43 MB
Mar 13' 2023
Notification 11.28.2018 PDL-Clinical PA Updates-Web Portal Info-Email
0.15 MB
Mar 13' 2023
Notification 12.01.2021 Clinical PA Updates-Web Portal Info-Email
0.17 MB
Mar 13' 2023
Notification 12.05.2018 Diabetic Supply Program
0.13 MB
Mar 13' 2023
Notification 12.10.2020 Prescriber Soft Edit
0.17 MB
Mar 13' 2023
Notification 12.23.2020 COVID-19 POS Billing Guidance
0.21 MB
Mar 13' 2023
Notification 12.31.2020 COVID-19 Billing Guidance update
0.21 MB
Mar 13' 2023
CMS Rebate Participating Manufacturers
0.25 MB
Mar 10' 2023
Diabetic Supply Covered Items List - Effective 10.1.2022
0.15 MB
Apr 25' 2023
Dose Optimization Program
0.01 MB
Mar 10' 2023
MAC Price Research Request Form
0.88 MB
Mar 10' 2023
Maintenance Medications
0.25 MB
Mar 10' 2023
Non-Legend Drug List
0.27 MB
May 12' 2023
Payer Specification
0.9 MB
Mar 10' 2023
Pharmacy Provider Manual - Revised 1.7.2022
0.98 MB
Mar 13' 2023
Preferred Drug List - Effective 9.1.2022
1 MB
Apr 25' 2023
Quantity Limit Program
0.23 MB
Mar 10' 2023
Third Party Liability Other Payer ID Codes
0.15 MB
Mar 10' 2023
Trading Partners FTP Instructions
0.44 MB
Mar 10' 2023
Dose Optimization Program
0.01 MB
Mar 10' 2023
Maintenance Medications
0.25 MB
Mar 10' 2023
Non-Legend Drug List
0.27 MB
May 12' 2023
Preferred Drug List - Effective 9.1.2022
1 MB
Apr 25' 2023
Quantity Limit Program
0.23 MB
Mar 10' 2023
Drug Coverage Lookup User Guide
1.13 MB
Mar 10' 2023
Multi-Ingredient Compound Reference
0.03 MB
Mar 10' 2023