List of Drugs That Require Prior Authorization

PDF Download: List of Drugs That Require Prior Authorization
Submit Drug PAs Online: Express Path
Drug Name Generic Name PA Program Disease State Submit PA or Call
Abraxane Paclitaxel Protein-Bound Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Abstral fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Actemra Tocilizumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Acthar Gel Repository Corticotropin Injection Medical Management/PA Metabolic, Immune Disorders or Inherited Rare Disease For Real-Time Response, Submit PA
OR Call (866) 877-7042
Actimmune Interferon Gamma-1b,Recomb. Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Actiq fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adcetris Brentuximab Vedotin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Adcirca Tadalafil Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adempas Riociguat Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adrucil Fluorouracil Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Advair Diskus Fluticasone Propionate and Salmeterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Advair HFA Fluticasone Propionate and Salmeterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Advate Antihemoph.FVIII, Full Length UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Adynovate Antihemophilic Factor VIII UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Afinitor (o) Everolimus Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Alecensa (o) Alectinib Hydrochloride Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Alimta Pemetrexed Disodium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Alkeran Melphalan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Alphanate Antihemophilic Factor/vWF UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
AlphaNine SD Factor IX UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Alprolix Factor IX Rec, Fc Fusion Protn UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Alunbrig Brigatinib Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Amifostine Amifostine Crystalline Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ampyra Dalfampridine Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Androderm topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
AndroGel topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Aralast NP Alpha-1-Proteinase Inhibitor Medical Management/PA Alpha 1 Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Aranesp Darbepoetin Alfa In Polysorbat Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arcalyst Rilonacept Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arranon Nelarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arzerra Ofatumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Atralin topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Aubagio Teriflunomide Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Austedo Deutetrabenazine Pharmacy PA Huntington's Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avastin Bevacizumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Aveed injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Avinza class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avita topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avonex Interferon Beta-1a Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Axiron topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Azacitidine Azacitidine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bebulin Factor IX Cplx(Pcc)#6, 3factor UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Beleodaq Belinostat Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bendeka Bendamustine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
BeneFIX Factor IX Human Recombinant UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Berinert C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Betaseron Interferon Beta-1b Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bicnu Carmustine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bivigam Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bleomycin Sulfate Bleomycin Sulfate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Blincyto Blinatumomab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Boniva Ibandronate Sodium Medical Management/PA Osteoporosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bosulif (o) Bosutinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Botox Onabotulinumtoxina Medical Management/PA Neuromuscular Conditions/Cosmetic For Real-Time Response, Submit PA
OR Call (866) 877-7042
Breo Ellipta Fluticasone and Vilanterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Brineura Cerliponase alfa Medical Management/PA Enzyme Deficiencies For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bunavail Buprenorphine HCl/Naloxone HCl Pharmacy PA Chemical Dependence For Real-Time Response, Submit PA
OR Call (800) 753-2851
Buprenorphine-Naloxone Buprenorphine HCl/Naloxone HCl Pharmacy PA Chemical Dependence For Real-Time Response, Submit PA
OR Call (800) 753-2851
Busulfex Busulfan Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bydureon GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Byetta GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cabometyx Cabozantinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Calcium Folinate Leucovorin Calcium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Camptosar Irinotecan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Capecitabine Capecitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Caprelsa Vandetanib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Carboplatin Carboplatin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Carimune NF Immun Glob G(IgG)/Sucr/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Chemet Succimer Pharmacy PA Chelating Agents For Real-Time Response, Submit PA
OR Call (800) 753-2851
Chenodal chenodiol Pharmacy PA Gallstones For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cholbam Cholic Acid Pharmacy PA Gi Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cialis tadalafil Pharmacy PA BPH For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cimzia Certolizumab Pegol Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cinqair reslizumab Medical Management/PA Respiratory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cinryze C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cisplatin Cisplatin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cladribine Cladribine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Clindamycin/Tretinoin Gel Clindamycin and Tretinoin Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Clolar Clofarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cometriq Cabozantinib S-Malate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Copaxone Glatiramer Acetate Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Copegus, Rebetol, Ribasphere Ribavirin Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Corifact Factor XIII UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Corlanor ivabradine Pharmacy PA Heart Failure For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cosentyx Secukinumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cosmegen Dactinomycin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cotellic Cobimetinib Fumarate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cuvitru Immune Globulin Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cyclophosphamide Cyclophosphamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cyramza Ramucirumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cytarabine Cytarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dacarbazine Dacarbazine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dacogen Decitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Daklinza daclatasvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Daliresp roflumilast Pharmacy PA Respiratory Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Daraprim Pyrimethamine Pharmacy PA Toxoplasmosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Darzalex Daratumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Daunorubicin HCl Daunorubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Daunoxome Daunorubicin Citrate Liposomal Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Decitabine Decitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Delatestryl injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Depo - Testosterone injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Depocyt Cytarabine Liposome/PF Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dexrazoxane Dexrazoxane HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Diclegis Doxylamine Succinate Pharmacy PA Nausea/Vomiting For Real-Time Response, Submit PA
OR Call (800) 753-2851
Docefrez Docetaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Docetaxel Docetaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Doxil Doxorubicin HCl Peg-Liposomal Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Doxorubicin HCl Doxorubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dulera Formoterol and Mometasone Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Dupixent Dupilumab Medical Management/PA Atopic Dermatitis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dysport Abobotulinumtoxina Medical Management/PA Neuromuscular Conditions/Cosmetic For Real-Time Response, Submit PA
OR Call (866) 877-7042
Egrifta Tesamorelin Acetate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eligard Leuprolide Acetate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eliquis Apixaban Pharmacy PA Cardiovascular Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Elitek Rasburicase Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ellence Epirubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Emflaza Deflazacort Pharmacy PA Duchenne Muscular Dystrophy For Real-Time Response, Submit PA
OR Call (800) 753-2851
Empliciti Elotuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Enbrel Etanercept Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Entresto sacubitril/valsartan Pharmacy PA Heart Failure For Real-Time Response, Submit PA
OR Call (800) 753-2851
Entyvio Vedolizumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epclusa Sofosubuvir/velpatasvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Epirubicin HCl Epirubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epogen Epoetin Alfa Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epoprostenol Sodium Epoprostenol Sodium (Glycine) Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Erbitux Cetuximab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Erivedge Vismodegib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Erwinaze Asparaginase (Erwinia Chrysan) Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Esbriet Pirfenidone Pharmacy PA Idiopathic Pulmonary Fibrosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Etopophos Etoposide Phosphate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Etoposide Etoposide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Euflexxa Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Exalgo class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Exjade Deferasirox Pharmacy PA Iron Chelator For Real-Time Response, Submit PA
OR Call (800) 753-2851
Exondys 51 Eteplirsen Medical Management/PA Duchenne Muscular Dystrophy For Real-Time Response, Submit PA
OR Call (866) 877-7042
Extavia Interferon Beta-1b Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eylea Aflibercept Medical Management/PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fabior topical tazarotene products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Farydak Panobinostat Lactate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Fasenra Benralizumab Medical Management/PA Asthma For Real-Time Response, Submit PA
OR Call (866) 877-7042
Faslodex Fulvestrant Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eloctate Antihemoph.FVIII Rec, Fc Fusion UHA Internal Clinical Review N/A Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Feiba NF Anti-Inhibitor Coagulant Comp. UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Fentora fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Ferriprox Deferiprone Pharmacy PA Iron Chelator For Real-Time Response, Submit PA
OR Call (800) 753-2851
Firazyr Icatibant Acetate Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Firmagon Degarelix Acetate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
First Testosterone topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Flebogamma DIF Immun Glob G(IgG)/Sorb/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Flolan Epoprostenol Sodium (Glycine) Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Floxuridine Floxuridine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fludarabine Phosphate Fludarabine Phosphate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fluorouracil Fluorouracil Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Folotyn Pralatrexate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Forteo Teriparatide Medical Management/PA Osteoporosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fortesta topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Fusilev Levoleucovorin Calcium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammagard Immun Glob G/Gly/Gluc/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammagard Liquid Immun Glob G/Gly/Gluc/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammagard S/D Immun Glob G/Gly/Gluc/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammaked Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammaplex Immun Glob G/Sorb/Gly/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gamunex Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gamunex-C Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gazyva Obinutuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gel-One Hyaluronate Sod, Cross-Linked Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gelsyn-3 Hyaluronic Acid 0.8% Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gemcitabine HCl Gemcitabine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gemzar Gemcitabine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Genotropin Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
GenVisc 850 Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gilenya Fingolimod HCl Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Gilotrif (o) Afatinib Dimaleate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Glassia Alpha-1-Proteinase Inhibitor Medical Management/PA Alpha 1 Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Glatopa Glatiramer Acetate Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gleevec (o) Imatinib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Granix Tbo-Filgrastim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Grastek Grass Pollen-Timothy, Standard Pharmacy PA Allergies For Real-Time Response, Submit PA
OR Call (800) 753-2851
Haegarda C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Halaven Eribulin Mesylate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Harvoni Ledipasvir/Sofosbuvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Helixate FS Antihemoph.FVIII, Full Length UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Hemlibra Emicizumab UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Hemofil M Antihemophilic Factor, Human UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Herceptin Trastuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hetlioz tasimelteon Pharmacy PA Sleep Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Hizentra Immun Glob G(IgG)/Pro/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
HP Acthar Corticotropin Medical Management/PA CNS/Autonomic Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Humate-P Antihemophilic Factor/vWF UHA Internal Clinical Review Hemophilia Submit PAs to UHA Health Care Services Fax (866) 572-4384 Phone (808) 532-4006
Humatrope Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Humira Adalimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hyalgan Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hycamtin Topotecan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hymovis Hyaluronic Acid injection Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
HyQvia IgG/Hyaluronidase,Recombinant Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ibrance (o) Palbociclib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Iclusig Ponatinib Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Idamycin PFS Idarubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Idarubicin HCl Idarubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ifex Ifosfamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ifosfamide Ifosfamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ilaris Canakinumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Imatinib Mesylate Imatinib Mesylate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Imbruvica Ibrutinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Imlygic Talimogene Laherparepvec Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Increlex Mecasermin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
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