Drug name
|
Criteria
|
| Standard chemotherapy criteria for medications without specific written requirements |
Standard chemotherapy criteria for medications without specific written requirements criteria |
| Standard criteria–ACA exceptions |
Standard criteria–ACA exceptions |
|
Standard criteria–compound medications
|
Standard criteria–compound medications criteria |
| Standard criteria–excess quantity limits |
Standard criteria–excess quantity limits criteria |
|
Standard criteria–medications without specific written requirements and off-label
|
Standard criteria–medications without specific written requirements and off-label criteria
|