Drug Criteria
5-ASA Derivatives Criteria [325KB]
Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys Criteria [297KB] Updated 3/15/2018
Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys PA Form [667KB] Updated 8/4/2014
Adult High Dose Antipsychotic Criteria [300KB] Updated 2/27/2017
Adult High Dose Antipsychotic PA Form [471KB] Added 5/11/2015
Albumin PA Form [1.49MB] Updated 8/4/2014
Aldurazyme Criteria [297KB]
Alinia Criteria [329KB] Updated 11/10/2015
Aloxi Crtieria [193KB] Updated 11/10/2015
Amitiza Criteria [344KB] Updated 1/7/2015
Ampyra Criteria [308KB] Updated 5/24/2018
Antidepressants (Age < 6 years) PA Form [120KB] Updated 12/11/2014
Antipsychotic (Age <6) PA Form [101KB] Updated 12/11/2014
Antipsychotic (Age 6 to <18) PA Form [155KB] Updated 12/11/2014
Aplenzin [3012KB] New 6/5/2015
Apokyn Criteria [290KB]
Aranesp Criteria [444KB] Updated 6/8/2018
Austedo Criteria [290KB] Added 4/25/2018
Automated Prior Authorizations and Bypass [1.06MB] Updated 10/1/2018
Banzel Criteria [343KB] Updated 4/23/2015
Benlysta Criteria [235KB] Updated 4/11/2017
Bone Resorption Inhibitor Criteria [441KB]
Boniva Injection Criteria [487KB] Updated 11/13/2015
Brisdelle Criteria [299KB] Updated 2/28/2018
Buprenorphine Agents Criteria [303KB] Updated 3/15/2018
Buprenorphine Agents PA Form [1.9MB] Updated 5/24/2017
Butalbital Criteria [241KB]
Carbaglu Crtieria [248KB]
Cayston Criteria [301KB] Updated 2/24/2015
Ceprotin Criteria [296KB] Updated 11/16/2015
Chantix Criteria [285KB]Updated 2/28/2018
Chemet [296KB] Added 10/15/2015
Chorionic Gonadotropin Criteria [195KB] Updated 11/16/2015
CII-V Edit Override Criteria [381KB] Updated 11/16/2015
Cinqair Criteria [340KB] Added 5/9/2018
Colcrys Criteria [341KB]
Cough and Cold Codeine Containing Products Criteria [192KB] Updated 5/10/2018
Crysvita Criteria [235KB] New 7/19/2018
Cubicin Criteria [300KB] Added 12/16/2015
Cyanocobalamin Criteria [129KB]
Cyramza Criteria [308KB] Updated 6/11/2015
Cytokines and CAM Antagonists Criteria [453KB] Updated 7/23/2018
Cytogam PA Form [589KB] Updated 10/24/2017
Daliresp Criteria [191KB] Added 6/27/2018
Dalvance Criteria [302KB] Updated 6/8/2018
Daraprim Criteria [273KB] Added 10/8/2015
Detrol Criteria [191KB]
Diastat Criteria [432KB]
Dibenzyline Criteria [190KB]
Dificid Criteria [335KB] Updated 11/16/2015
Dupixent Criteria [178KB] Added 1/8/2018
Edurant Criteria [371KB] Updated 11/16/2015
Elaprase Criteria [290KB]
Elmiron Criteria [307KB] Updated 11/16/2015
Emflaza Criteria [198KB] Updated 7/10/2017
Epaned Criteria [195KB] Updated 8/7/2017
Erwinaze Criteria [331KB]
Esbriet Criteria [303KB] Updated 3/28/2018
Exjade Criteria [387KB] Updated 3/30/2015
Exondys 51 Criteria [387KB] Updated 8/28/2017
Exondys PA Form [1.79MB] Added 10/24/2017
Fasenra Criteria [424KB] Added 5/9/2018
Ferriprox Criteria [318KB] Update 8/7/2015
Fetzima Criteria [ 339KB] Updated 6/15/2016
Forteo Criteria [348KB] Updated 4/3/2018
Fulyzaq Criteria [382KB]
Fuzeon PA Form [244KB]
Gattex Criteria [304KB] Updated 11/20/2014
H.P. Acthar Gel Criteria [358KB] Updated 2/28/2018
Hemangeol Criteria [481KB] Added 12/3/2014
Hepatitis C Agents Criteria [435KB] Updated 9/7/2018
Hepatitis C Agents Form [1.52MB] Updated 2/16/2018
Hetlioz Criteria [436KB] Added 8/28/2014
HIV Auto PA Form [358KB] Updated 5/16/2018
HIV Diagnosis Verification Form [598KB] Updated 10/30/2017
Human Growth Hormone Criteria [778KB] Updated 3/6/2018
Human Growth Hormone PA Form [623KB] Updated 3/3/2017
Ingrezza Criteria [285KB] Added 4/25/2018
Increlex PA Form [2.32MB] Updated 1/18/2017
Invega Oral Criteria [217KB] Updated 6/5/2015
IVIG Criteria [592KB] Updated 7/21/2017
Jadenu Criteria [382KB] Added 6/1/2015
Jardiance [304KB] Updated 12/19/2016
Juxtapid Criteria [298KB] Updated 12/19/2016
Kadcyla Criteria [300KB] Updated 11/18/2015
Kalydeco Critieria [386KB] Updated 8/28/2018
Kapvay Critieria [320KB] Updated 11/19/2015
Kepivance Critieria [124KB]
Korlym Criteria [389KB]
Kuvan Criteria [304KB] Updated 5/13/2015
Kymriah Criteria [281KB] Updated 7/27/2018
Kynamro Criteria [295KB]
Lacrisert Criteria [314KB]
Lioresal/Gablofen Criteria [295KB]
Long Acting Beta 2 Agonists Criteria [354KB] Updated 1/23/2018
Long Acting Stimulants in Children Criteria [282KB] Added 6/18/2015
Lovaza Criteria [139KB] Added 12/1/2016
Lumizyme Criteria [282KB] Added 2/21/2018
Luxturna Criteria [379KB] Added 3/27/18
Makena Criteria [298KB] Updated 11/6/2017
Marinol Criteria [181KB] Updated 6/8/2016
Mepsevii Criteria [279KB] New 7/19/2018
Methadone Criteria [511KB] Update 3/15/2018
Mircera Criteria [306KB] Updated 6/12/2018
Miscellaneous Drug Criteria [227KB] Updated 5/16/2017
Miscellaneous Pharmacy Prior Authorization Requests [1.02MB] Updated 5/18/2015
Morphine Sulfate ER Criteria [464KB] Update 3/15/2018
Mozobil Criteria [309KB] Updated 11/6/2017
Multi Source Brand Drug PA Form [1.72MB] Updated 6/8/2015
Multiple Sclerosis Oral Agents Criteria [294KB] Updated 5/24/2018
Myrbetriq Criteria [294KB] Updated 11/19/2015
Naglazyme Criteria [498KB]
Namenda XR Criteria [348KB] Added 6/23/2015
Natacyn Criteria [293KB]
Neumega Criteria [300KB]
Neupogen/Leukine/Neulasta/Granix/Zarxio/Fulphia PA Form [1.49MB] Updated 7/23/2018
Neupro Criteria [441KB] Updated 11/19/2015
Nityr PA Form [591KB] Added 3/27/2018
Nucala Criteria [346KB] Added 5/9/2018
Nucynta Criteria [290KB]
Nuedexta Criteria [299KB] Updated 6/5/2015
Nuplazid Criteria [291KB] Updated 8/8/2018
Ofev Criteria [298KB] Added 10/22/2015
Off Label Use Criteria [182KB] Updated 8/30/2017
Opioid PA Form [2.26MB] Updated 7/02/2018
Oral Oncology Criteria [742KB] Updated 8/28/2018
Oral Oncology PA Form [1.03MB] Updated 8/4/2014
Oravig Criteria [190KB]
Orbactiv Criteria [309KB] Added 5/21/2015
Orfadin PA Form [591KB] Updated 3/27/2018
Orkambi Criteria [309KB] Updated 8/10/2018
Otrexup Criteria [198KB] Added 7/27/2016
Oxandrin Criteria [153KB] Updated 12/22/2016
Oxycontin PA Form [1.40MB] Updated 4/5/2018
Panretin PA Form [59KB] Updated 5/18/2015
Praluent Criteria [323KB] Added 10/8/2015
ProCentra Criteria [295KB] Updated 11/20/2015
Procrit/Retacrit Criteria [466KB] Updated 7/9/2018
Procrit/Aranesp PA Form [1.48MB] Updated 8/11/2017
Proleukin PA Form [73KB]
Prolia Criteria [575KB] Updated 6/5/2018
Promacta Criteria [404KB] Updated 7/31/2018
Proton Pump Inhibitors [489KB] Added 7/11/2016
Pulmonary Hypertension Agent Criteria [392KB] Updated 2/22/2016
Rasuvo Criteria [98KB] Added 7/27/2016
Ravicti Criteria [314KB] Updated 6/29/2018
Rectiv Criteria [354KB]
Regranex Criteria [195KB]
Relistor Criteria [301KB] Updated 11/23/2015
Repatha Criteria [331KB] Updated 7/16/2018
Rexulti Criteria [245KB] Added 11/29/2016
Samsca Criteria [446KB] Updated 7/10/2017
Sancuso Criteria [196KB] Updated 1/15/2015
Sandostatin LAR Criteria [354KB] Updated 4/6/2015
Saphris Criteria [358KB] Updated 11/6/2015
Sedative Hypnotic Criteria [476KB] Updated 11/2/2016
Selzentry PA Form [139KB]
Sensipar Criteria [316KB]
Serostim PA Form [245KB]
Sirturo Criteria [297KB]
Soliris Criteria [70KB] Updated 11/15/2017
Soma PA Form [481KB] Updated 6/13/2016
Spinraza Criteria [454KB] Updated 8/28/2017
Spinraza PA Form [1.81MB] Added 10/24/2017
Stimulants and Strattera (<6 years of age) PA Form [499KB] Added 8/18/2015
Supprelin LA Criteria [298KB] Updated 11/4/2015
Supprelin LA PA Form [62KB] Updated 8/4/2014
Sylatron Criteria [445KB]
Symdeko Criteria [434KB] Updated 6/18/2018
Synagis Criteria [365KB] Updated 6/15/2018
Synagis - All Florida Regions Combined PA Form [1.94MB] Updated 8/27/2018
Synagis - Weight Change PA Form [1.40MB] Updated 8/27/2018
Synribo Criteria [301KB] Updated 11/23/2015
Testosterone Criteria [526KB] Updated 2/24/2016
Trogarzo Criteria [429KB] Updated 8/6/2018
Tygacil Criteria [141KB]
Tymlos Criteria [341KB] Added 4/3/2018
Valcyte Criteria [156KB] Updated 5/16/2017
Valcyte Form [1.01MB] Updated 3/20/2017
Vecamyl Criteria [313KB] Updated 3/14/2018
Venofer Criteria [277KB] Added 1/8/2018
Veregen Criteria [194KB]
Vfend PA Form [107KB]
Vibativ Criteria [310KB]
Viberzi Criteria [193KB] Added 4/5/2018
Victoza Criteria [220KB] Updated 12/22/2016
Vimizim Criteria [232KB]
Xenazine Criteria [214KB] Updated 7/16/2018
Xermelo Criteria [248KB] Added 12/21/2017
Xgeva Criteria [311KB] Updated 11/23/2015
Xifaxan Criteria [359KB] Updated 11/23/2015
Xolair Criteria [130KB] Updated 3/30/2017
Xopenex Criteria [228KB] Updated 3/30/2015
Xyrem Criteria [205KB] Updated 10/25/2017
Yescarta Criteria [512KB] Added 12/22/2017
Zortress Criteria [109KB]
Zyprexa Relprevv [230KB] Updated 9/8/2017
Zyvox Criteria [218KB]