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Our decision-making process
Some medications on our formulary need prior authorization before they can be dispensed. First, you’ll request prior authorization for a member’s medication. Then, we’ll review your request and make our decision using the Maryland Department of Health’s prior authorization guidelines as well as our own custom guidelines.
Here are some of the guidelines we use in our decision making:
Hepatitis C guidelines
You can find more information on the Maryland Department of Health’s website, including their:
- Hepatitis C clinical criteria
- Hepatitis C sample enhanced treatment plan
- Hepatitis C sample treatment plan