-
1
Physician Specialty Overview by Prior Authorization Approval or
Denial4th Quarter 2019
9431 4/20
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3951 DERMATOLOGY Absorica (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3952 FAMILY PRACTICE Absorica (isotretinoin) DERMATOLOGICAL
AGENTS No Response 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica (isotretinoin)
DERMATOLOGICAL AGENTS Approval 2
3951 FAMILY PRACTICE Absorica 20MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica 30MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Absorica 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 2
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica 30MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 DERMATOLOGY Absorica 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Absorica 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 2
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Absorica 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 3
3951 PRESCRIBER SPECIALTY, UNKNOWN Acamprosate Calcium 333MG OR
TBEC SUBSTANCE ABUSE AGENTS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Acamprosate Calcium 333MG OR
TBEC SUBSTANCE ABUSE AGENTS Approval 1
3956 FAMILY PRACTICE Acamprosate Calcium 333MG OR TBEC SUBSTANCE
ABUSE AGENTS Approval 5
3963 FAMILY PRACTICE acetaminophen 300 mg-codeine 30 mg tablet
(TYLE-NOL #3) NARCOTIC ANALGESICS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Acetaminophen-Codeine #3
300-30MG OR TABS NARCOTIC ANALGESICS No Response 1
3956 FAMILY PRACTICE Acetaminophen-Codeine #4 300-60MG OR TABS
NARCOTIC ANALGESICS Approval 1
3963 DERMATOLOGY Acitretin 10MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3963 DERMATOLOGY Acitretin 25MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3956 RHEUMATOLOGY Actemra IMMUNOSUPPRESSIVES/DMARDS Approval
1
3961 PRESCRIBER SPECIALTY, UNKNOWN Actemra
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3961 INTERNAL MEDICINE Actemra IMMUNOSUPPRESSIVES/DMARDS
Approval 1
3951 INTERNAL MEDICINE Acthar Gel ANTICONVULSANTS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX CREA
ANTIVIRALS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX CREA
ANTIVIRALS Approval 1
3963 FAMILY PRACTICE Acyclovir 5% EX CREA ANTIVIRALS Approval
1
3963 NURSE PRACTITIONER, UNSPECIFIED Acyclovir 5% EX CREA
ANTIVIRALS Approval 1
3951 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS Approval
1
3952 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS Approval
1
-
2
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 OBSTETRICS & GYNECOLOGY Acyclovir 5% EX OINT ANTIVIRALS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir 5% EX OINT
ANTIVIRALS Approval 2
3963 DENTIST, GENERAL PRACTICE Acyclovir 5% EX OINT ANTIVIRALS
Approval 2
3963 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS Approval
2
3963 FAMILY PRACTICE Acyclovir 5% EX OINT ANTIVIRALS No Response
2
3963 NURSE PRACTITIONER, FAMILY HEALTH Acyclovir 5% EX OINT
ANTIVIRALS Approval 1
3963 NURSE PRACTITIONER, UNSPECIFIED Acyclovir 5% EX OINT
ANTIVIRALS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Acyclovir 5% EX OINT
ANTIVIRALS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir Cream ANTIVIRALS
Approval 1
3963 FAMILY PRACTICE Acyclovir Cream ANTIVIRALS Approval 1
3963 PHYSICIAN, SURGERY, GENERAL Acyclovir Cream ANTIVIRALS
Denial 1
3951 FAMILY PRACTICE Acyclovir Oint ANTIVIRALS Denial 1
3951 INTERNAL MEDICINE Acyclovir Oint ANTIVIRALS Denial 1
3951 FAMILY PRACTICE Acyclovir Ointment ANTIVIRALS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Acyclovir Ointment ANTIVIRALS
No Response 1
3956 NURSE PRACTITIONER, FAMILY HEALTH Adapalene 0.3% EX GEL
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Adapalene 0.3% EX GEL DERMATOLOGICAL AGENTS
Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Adapalene 0.3% EX GEL
DERMATOLOGICAL AGENTS Approval 1
3956 FAMILY PRACTICE Adapalene Cream DERMATOLOGICAL AGENTS
Denial 1
3952 FAMILY PRACTICE Adderall 20MG OR TABS CNS STIMULANTS
Approval 1
3956 FAMILY PRACTICE Adderall 30MG OR TABS CNS STIMULANTS
Approval 1
3956 PSYCHIATRY, CHILD & ADOLESCENT Adderall 30MG OR TABS
CNS STIMULANTS No Response 1
3963 ANESTHESIOLOGY Adderall 30MG OR TABS CNS STIMULANTS
Approval 1
3963 INTERNAL MEDICINE Adderall 30MG OR TABS CNS STIMULANTS
Approval 1
3956 NEUROLOGY Adderall XR 25MG OR CP24 CNS STIMULANTS No
Response 1
3956 NEUROLOGY Adderall XR 30MG OR CP24 CNS STIMULANTS Denial
1
3952 PHYSICIAN, ONCOLOGY, MEDICAL Afinitor ANTINEOPLASTICS
Denial 1
3963 MEDICAL ONCOLOGY Afinitor ANTINEOPLASTICS Approval 1
3963 ONCOLOGY, GYNECOLOGIC Afinitor ANTINEOPLASTICS Approval
1
3963 ONCOLOGY, GYNECOLOGIC Afinitor ANTINEOPLASTICS No Response
1
3956 GASTROENTEROLOGY Alosetron GASTROINTESTINAL AGENTS Approval
2
3961 FAMILY PRACTICE Alosetron HCl 0.5MG OR TABS
GASTROINTESTINAL AGENTS Denial 1
3963 DERMATOLOGY Altreno 0.05% EX LOTN DERMATOLOGICAL AGENTS
Approval 1
3952 DERMATOLOGY Amnesteem (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem (isotretinoin)
DERMATOLOGICAL AGENTS Approval 1
3956 DERMATOLOGY Amnesteem (isotretinoins) DERMATOLOGICAL AGENTS
Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem (isotretinoins)
DERMATOLOGICAL AGENTS Approval 1
-
3
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3951 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3961 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Amnesteem 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3956 DERMATOLOGY Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Amnesteem 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Amnesteem 40MG OR CAPS
DERMATOLOGICAL AGENTS No Response 1
3956 PSYCHIATRY Amphetamine-Dextroamphet ER 20MG OR CP24 CNS
STIMULANTS Approval 3
3956 PSYCHIATRY Amphetamine-Dextroamphet ER 20MG OR CP24 CNS
STIMULANTS No Response 1
3951 FAMILY PRACTICE Amphetamine-Dextroamphet ER 30MG OR CP24
CNS STIMULANTS Approval 1
3951 PEDIATRICS Amphetamine-Dextroamphet ER 30MG OR CP24 CNS
STIMULANTS Approval 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphet ER 30MG OR CP24
CNS STIMULANTS Approval 1
3956 PSYCHIATRY Amphetamine-Dextroamphet ER 30MG OR CP24 CNS
STIMULANTS Approval 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphet ER 30MG OR CP24
CNS STIMULANTS Approval 1
3963 NEUROLOGY Amphetamine-Dextroamphet ER 30MG OR CP24 CNS
STIMULANTS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
10mg Tab CNS STIMULANTS Denial 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 12.5MG OR
TABS CNS STIMULANTS Approval 1
3956 GENERAL PRACTICE Amphetamine-Dextroamphetamine 15mg ER CNS
STIMULANTS Approval 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 15mg ER CNS
STIMULANTS Approval 1
3961 FAMILY PRACTICE Amphetamine-Dextroamphetamine 15MG OR TABS
CNS STIMULANTS Approval 1
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 15MG OR TABS CNS
STIMULANTS Approval 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 15mg Tab CNS
STIMULANTS No Response 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg CNS
STIMULANTS Approval 2
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg ER CNS
STIMULANTS Approval 1
3956 PEDIATRICS Amphetamine-Dextroamphetamine 20mg ER CNS
STIMULANTS Approval 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg ER CNS
STIMULANTS Approval 5
3961 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
20mg ER CNS STIMULANTS Approval 2
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg ER CNS
STIMULANTS No Response 2
3951 PSYCHIATRY Amphetamine-Dextroamphetamine 20MG OR TABS CNS
STIMULANTS Approval 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20MG OR TABS
CNS STIMULANTS Approval 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20MG OR TABS CNS
STIMULANTS Approval 3
3956 PSYCHIATRY, CHILD & ADOLESCENT
Amphetamine-Dextroamphetamine 20MG OR TABS CNS STIMULANTS Approval
1
3956 REGISTERED NURSE, UNSPECIFIED Amphetamine-Dextroamphetamine
20MG OR TABS CNS STIMULANTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
20MG OR TABS CNS STIMULANTS Approval 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20MG OR TABS
CNS STIMULANTS Approval 1
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 20MG OR TABS CNS
STIMULANTS Approval 1
-
4
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 20mg Tab CNS
STIMULANTS Approval 3
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg Tab CNS
STIMULANTS Approval 2
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg Tab CNS
STIMULANTS No Response 1
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 20mg Tab CNS
STIMULANTS Approval 1
3956 NEUROLOGY Amphetamine-Dextroamphetamine 25mg ER CNS
STIMULANTS Denial 1
3951 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS
STIMULANTS Approval 2
3951 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS
STIMULANTS Denial 2
3951 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg CNS
STIMULANTS Approval 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS
STIMULANTS Approval 2
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg CNS
STIMULANTS Denial 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg ER CNS
STIMULANTS Approval 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg ER CNS
STIMULANTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
30MG OR TABS CNS STIMULANTS Approval 1
3951 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
30MG OR TABS CNS STIMULANTS Approval 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 7
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS No Response 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30MG OR TABS CNS
STIMULANTS Approval 3
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30MG OR TABS CNS
STIMULANTS No Response 1
3956 PSYCHIATRY, CHILD & ADOLESCENT
Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval
2
3956 REGISTERED NURSE, UNSPECIFIED Amphetamine-Dextroamphetamine
30MG OR TABS CNS STIMULANTS Approval 1
3961 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 1
3961 GENERAL PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
30MG OR TABS CNS STIMULANTS Approval 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 2
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30MG OR TABS
CNS STIMULANTS Approval 4
3963 NURSE PRACTITIONER, FAMILY HEALTH
Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval
1
3963 NURSE PRACTITIONER, UNSPECIFIED
Amphetamine-Dextroamphetamine 30MG OR TABS CNS STIMULANTS Approval
1
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 30MG OR TABS CNS
STIMULANTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Amphetamine-Dextroamphetamine
30mg Tab CNS STIMULANTS Approval 1
3951 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Approval 1
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Approval 7
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Denial 3
3956 FAMILY PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS No Response 3
3956 GENERAL PRACTICE Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Denial 1
3956 PEDIATRICS Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Denial 1
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Approval 8
-
5
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Denial 2
3961 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Approval 2
3963 PSYCHIATRY Amphetamine-Dextroamphetamine 30mg Tab CNS
STIMULANTS Approval 1
3951 PSYCHIATRY Amphetamine-Dextroamphetamine ER 20mg CNS
STIMULANTS Approval 1
3951 PSYCHIATRY Amphetamine-Dextroamphetamine ER 20mg CNS
STIMULANTS Denial 1
3952 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS
STIMULANTS Denial 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS
STIMULANTS Approval 2
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 20mg CNS
STIMULANTS Denial 1
3952 PSYCHIATRY Amphetamine-Dextroamphetamine ER 30mg CNS
STIMULANTS No Response 1
3963 FAMILY PRACTICE Amphetamine-Dextroamphetamine ER 30mg CNS
STIMULANTS Approval 1
3952 INTERNAL MEDICINE Androderm (testosterone transdermal
patch) ANDROGENS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Androderm (testosterone
transdermal patch) ANDROGENS Approval 1
3952 INTERNAL MEDICINE Androderm 4MG/24HR TD PT24 ANDROGENS No
Response 1
3954 FAMILY PRACTICE Androgel (testosterone transdermal gel)
ANDROGENS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Androgel (testosterone
transdermal gel) ANDROGENS Approval 1
3963 FAMILY PRACTICE Androgel (testosterone transdermal gel)
ANDROGENS Approval 1
3951 ENDOCRINOLOGY, DIABETES & METABOLISM AndroGel 20.25
MG/1.25GM(1.62%) TD GEL ANDROGENS Approval 1
3956 ANESTHESIOLOGY APAP/Codeine Tab 300-30 mg NARCOTIC
ANALGESICS Approval 1
3963 FAMILY PRACTICE APAP-Codeine Tab 300-30 mg NARCOTIC
ANALGESICS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN APAP-Codeine Tab 300-60 mg
NARCOTIC ANALGESICS Approval 1
3961 NEUROLOGY Aptiom (eslicarbazepine) ANTICONVULSANTS Approval
1
3952 NEPHROLOGY / RENAL MEDICINE Aranesp HEMATINICS & BLOOD
CELL STIMULATORS No Response 1
3963 HEMATOLOGY Aranesp HEMATINICS & BLOOD CELL STIMULATORS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil CNS STIMULANTS
Approval 1
3956 NEUROLOGY Armodafinil CNS STIMULANTS Denial 3
3956 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil CNS
STIMULANTS Denial 1
3956 PSYCHIATRY Armodafinil CNS STIMULANTS Approval 1
3956 PSYCHIATRY Armodafinil CNS STIMULANTS Denial 2
3956 FAMILY PRACTICE Armodafinil 150 MG Oral Tablet
PSYCHOSTIMULANTS-ANTIDEPRESSANTS Approval 1
3952 NURSE PRACTITIONER, UNSPECIFIED Armodafinil 150MG OR TABS
CNS STIMULANTS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil 150MG OR TABS CNS
STIMULANTS Approval 1
3956 NEUROLOGY Armodafinil 150MG OR TABS CNS STIMULANTS Approval
1
3956 PULMONARY DISEASES Armodafinil 150MG OR TABS CNS STIMULANTS
Approval 4
3961 FAMILY PRACTICE Armodafinil 150MG OR TABS CNS STIMULANTS
Approval 1
3963 NEUROLOGY Armodafinil 150MG OR TABS CNS STIMULANTS Approval
1
3963 NURSE PRACTITIONER, WOMEN’S HEALTH armodafinil 200 mg
tablet CNS STIMULANTS No Response 1
3951 PULMONARY DISEASES Armodafinil 200MG OR TABS CNS STIMULANTS
Approval 2
-
6
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil 200MG OR TABS CNS
STIMULANTS Approval 1
3956 PSYCHIATRY Armodafinil 200MG OR TABS CNS STIMULANTS
Approval 1
3961 FAMILY PRACTICE Armodafinil 200MG OR TABS CNS STIMULANTS
Approval 1
3963 FAMILY PRACTICE Armodafinil 200MG OR TABS CNS STIMULANTS
Approval 1
3963 INTERNAL MEDICINE Armodafinil 200MG OR TABS CNS STIMULANTS
Approval 1
3956 FAMILY PRACTICE Armodafinil 250MG OR TABS CNS STIMULANTS
Approval 1
3956 NURSE PRACTITIONER, ACUTE CARE Armodafinil 250MG OR TABS
CNS STIMULANTS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil 250MG OR TABS
CNS STIMULANTS Approval 1
3963 FAMILY PRACTICE Armodafinil 250MG OR TABS CNS STIMULANTS
Denial 1
3963 NEUROLOGY Armodafinil 250MG OR TABS CNS STIMULANTS Approval
2
3963 NURSE PRACTITIONER, FAMILY HEALTH Armodafinil 250MG OR TABS
CNS STIMULANTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Armodafinil Tablets CNS
STIMULANTS Denial 1
3951 FAMILY PRACTICE Armodafinil Tablets CNS STIMULANTS Denial
1
3951 NURSE PRACTITIONER, UNSPECIFIED Armodafinil Tablets CNS
STIMULANTS Approval 1
3951 PULMONARY DISEASES Armodafinil Tablets CNS STIMULANTS
Approval 1
3952 NURSE PRACTITIONER, UNSPECIFIED Armodafinil Tablets CNS
STIMULANTS Approval 1
3963 FAMILY PRACTICE Armodafinil Tablets CNS STIMULANTS Approval
1
3963 NEUROLOGY Armodafinil Tablets CNS STIMULANTS Approval 1
3952 NURSE PRACTITIONER, FAMILY HEALTH Aubagio MULTIPLE
SCLEROSIS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Aubagio MULTIPLE SCLEROSIS No
Response 1
3956 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 1
3961 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 1
3961 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Aubagio MULTIPLE SCLEROSIS
Approval 1
3963 NURSE PRACTITIONER, UNSPECIFIED Aubagio MULTIPLE SCLEROSIS
Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Aubagio MULTIPLE SCLEROSIS
Denial 2
3956 NEUROLOGY Avonex MULTIPLE SCLEROSIS No Response 1
3961 NEUROLOGY Avonex MULTIPLE SCLEROSIS No Response 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Avonex MULTIPLE SCLEROSIS
Approval 1
3956 NEUROLOGY Avonex Pen 30MCG/0.5ML IM AJKT MULTIPLE SCLEROSIS
Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Azelaic Acid DERMATOLOGICAL
AGENTS Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid
DERMATOLOGICAL AGENTS Denial 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid
DERMATOLOGICAL AGENTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Azelaic Acid DERMATOLOGICAL
AGENTS Approval 2
3963 DERMATOLOGY Azelaic Acid DERMATOLOGICAL AGENTS Denial 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED AZELAIC ACID 15% GEL
DERMATOLOGICAL AGENTS Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL
DERMATOLOGICAL AGENTS Denial 1
-
7
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 DERMATOLOGY Azelaic Acid 15% EX GEL DERMATOLOGICAL AGENTS
Approval 1
3952 NURSE PRACTITIONER, UNSPECIFIED Azelaic Acid 15% EX GEL
DERMATOLOGICAL AGENTS Denial 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL
DERMATOLOGICAL AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL
DERMATOLOGICAL AGENTS Denial 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Azelaic Acid 15% EX GEL
DERMATOLOGICAL AGENTS Approval 2
3952 PRESCRIBER SPECIALTY, UNKNOWN Belbuca 150MCG BU FILM
NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY Belbuca 150MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca 150MCG BU FILM
NARCOTIC ANALGESICS Approval 2
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Belbuca 150MCG BU FILM NARCOTIC ANALGESICS Approval
1
3961 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca 150MCG BU FILM
NARCOTIC ANALGESICS No Response 1
3951 GENERAL PRACTICE Belbuca 150mcg Buccal Film (buprenorphine)
NARCOTIC ANALGESICS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Belbuca 150mcg Buccal
Film (buprenorphine) NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY Belbuca 300MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3951 ANESTHESIOLOGY Belbuca 300mcg Buccal Film (buprenorphine)
NARCOTIC ANALGESICS Approval 1
3963 ANESTHESIOLOGY Belbuca 450mcg Buccal Film (buprenorphine)
NARCOTIC ANALGESICS Approval 1
3963 ANESTHESIOLOGY Belbuca 450mcg Buccal Film (buprenorphine)
NARCOTIC ANALGESICS Denial 1
3953 ANESTHESIOLOGY Belbuca 600MCG BU FILM NARCOTIC ANALGESICS
Denial 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Belbuca 600MCG BU FILM
NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY Belbuca 600MCG BU FILM NARCOTIC ANALGESICS
Approval 3
3953 ANESTHESIOLOGY Belbuca 600mcg Buccal Film (buprenorphine)
NARCOTIC ANALGESICS No Response 1
3956 FAMILY PRACTICE Belbuca 750MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3951 ANESTHESIOLOGY Belbuca 75MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3956 FAMILY PRACTICE Belbuca 75MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3963 ANESTHESIOLOGY Belbuca 75MCG BU FILM NARCOTIC ANALGESICS
Approval 2
3951 ANESTHESIOLOGY Belbuca 900MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3956 ANESTHESIOLOGY Belbuca 900MCG BU FILM NARCOTIC ANALGESICS
No Response 1
3961 EMERGENCY MEDICINE Belbuca 900MCG BU FILM NARCOTIC
ANALGESICS Approval 1
3963 ANESTHESIOLOGY Belbuca 900MCG BU FILM NARCOTIC ANALGESICS
Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Belbuca Mis 300 mcg
(buprenorphine buccal film) NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY Belbuca Mis 75 mcg (buprenorphine buccal
film) NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY Belbuca Mis 900 mcg (buprenorphine buccal
film) NARCOTIC ANALGESICS Approval 1
3963 FAMILY PRACTICE bosentan VASODILATOR Approval 1
3963 GENERAL PRACTICE bosentan VASODILATOR Approval 1
3963 PEDIATRICS bosentan VASODILATOR Approval 1
3963 PSYCHIATRY bosentan VASODILATOR Approval 1
3961 HEMATOLOGY & ONCOLOGY Bosulif ANTINEOPLASTICS No
Response 1
-
8
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 PRESCRIBER SPECIALTY, UNKNOWN Braftovi ANTINEOPLASTICS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Braftovi ANTINEOPLASTICS
Approval 1
3956 NEUROLOGY Briviact 100MG OR TABS ANTICONVULSANTS Approval
1
3956 PRESCRIBER SPECIALTY, UNKNOWN Briviact 50MG OR TABS
ANTICONVULSANTS Approval 1
3961 NEUROLOGY Briviact Tablet (brivaracetam) ANTICONVULSANTS
Approval 1
3952 GASTROENTEROLOGY BUDESONIDE 0.5MG/2ML AMPUL-NEB RESPIRATORY
AGENTS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN BUDESONIDE 1MG/2ML AMPUL-NEB
RESPIRATORY AGENTS Denial 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Buprenorphine 15MCG/HR TD
PTWK NARCOTIC ANALGESICS Approval 1
3963 ANESTHESIOLOGY Buprenorphine 20MCG/HR TD PTWK NARCOTIC
ANALGESICS Approval 1
3963 INTERNAL MEDICINE Buprenorphine 20MCG/HR TD PTWK NARCOTIC
ANALGESICS No Response 1
3956 ANESTHESIOLOGY Buprenorphine HCl 2MG SL SUBL SUBSTANCE
ABUSE AGENTS Denial 2
3952 EMERGENCY MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE
ABUSE AGENTS No Response 1
3956 ANESTHESIOLOGY Buprenorphine HCl 8MG SL SUBL SUBSTANCE
ABUSE AGENTS Denial 1
3956 EMERGENCY MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE
ABUSE AGENTS Approval 1
3956 FAMILY PRACTICE Buprenorphine HCl 8MG SL SUBL SUBSTANCE
ABUSE AGENTS Denial 2
3956 INTERNAL MEDICINE Buprenorphine HCl 8MG SL SUBL SUBSTANCE
ABUSE AGENTS Denial 2
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE AGENTS
Approval 1
3956 PSYCHIATRY Buprenorphine HCl 8MG SL SUBL SUBSTANCE ABUSE
AGENTS No Response 2
3956 ANESTHESIOLOGY Buprenorphine HCl-Naloxone HCl 8-2MG SL SUBL
SUBSTANCE ABUSE AGENTS No Response 1
3956 ANESTHESIOLOGY Buprenorphine SL 2 mg Tab SUBSTANCE ABUSE
AGENTS Denial 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Buprenorphine SL 8 mg Tab
SUBSTANCE ABUSE AGENTS Denial 1
3956 ANESTHESIOLOGY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 3
3956 FAMILY PRACTICE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 3
3956 GASTROENTEROLOGY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 1
3956 INTERNAL MEDICINE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 6
3956 PEDIATRICS Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS
Denial 1
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS Denial
1
3956 PSYCHIATRY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE AGENTS
Denial 2
3963 ANESTHESIOLOGY Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 1
3963 FAMILY PRACTICE Buprenorphine SL 8 mg Tab SUBSTANCE ABUSE
AGENTS Denial 1
3951 FAMILY PRACTICE Buprenorphine Sublingual Tablets SUBSTANCE
ABUSE AGENTS Denial 1
3963 EMERGENCY MEDICINE Buprenorphine Sublingual Tablets
SUBSTANCE ABUSE AGENTS Denial 1
3956 NURSE PRACTITIONER, FAMILY HEALTH
BUTALBITAL-ACETAMINOPHEN-CA--325-40-50 NON-NARCOTIC ANALGESICS No
Response 1
3956 ANESTHESIOLOGY Butorphanol Tartrate 10MG/ML NA SOLN
NARCOTIC ANALGESICS Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Butrans 15MCG/HR TD PTWK
NARCOTIC ANALGESICS Approval 1
3951 NURSE PRACTITIONER, FAMILY HEALTH Butrans 15MCG/HR TD PTWK
NARCOTIC ANALGESICS Approval 1
-
9
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 FAMILY PRACTICE Butrans 15MCG/HR TD PTWK NARCOTIC
ANALGESICS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Butrans 15MCG/HR TD PTWK
NARCOTIC ANALGESICS Approval 1
3951 ANESTHESIOLOGY Butrans 20mcg/hr TD Patch (buprenorphine)
NARCOTIC ANALGESICS Approval 1
3951 FAMILY PRACTICE Butrans 20mcg/hr TD Patch (buprenorphine)
NARCOTIC ANALGESICS No Response 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Butrans 20MCG/HR TD PTWK
NARCOTIC ANALGESICS Approval 1
3952 PAIN MEDICINE Butrans 20MCG/HR TD PTWK NARCOTIC ANALGESICS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Butrans 20MCG/HR TD PTWK
NARCOTIC ANALGESICS Approval 1
3963 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS Approval 1
3963 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS No Response
1
3956 HEMATOLOGY & ONCOLOGY Calquence ANTINEOPLASTICS Denial
1
3951 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS
Approval 1
3951 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS No
Response 1
3952 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS
No Response 1
3956 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS
Approval 2
3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS
Approval 2
3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS
Denial 1
3956 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Approval
2
3956 MEDICAL ONCOLOGY capecitabine ANTINEOPLASTICS Approval
2
3956 MEDICAL ONCOLOGY capecitabine ANTINEOPLASTICS No Response
1
3961 PRESCRIBER SPECIALTY, UNKNOWN capecitabine ANTINEOPLASTICS
Approval 1
3963 HEMATOLOGY capecitabine ANTINEOPLASTICS Approval 1
3963 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS
Approval 1
3963 PHYSICIAN, ONCOLOGY, MEDICAL capecitabine ANTINEOPLASTICS
Approval 1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cerdelga ENZYME INHIBITOR
Approval 1
3956 FAMILY PRACTICE CHANTIX 1MG TABLET SMOKING CESSATION AGENTS
No Response 1
3956 FAMILY PRACTICE Cialis 5MG OR TABS VASODILATORS Approval
1
3951 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox (topical solution
8%) ANTIFUNGALS Denial 1
3951 DERMATOLOGY Ciclopirox (topical solution 8%) ANTIFUNGALS
Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox (topical solution
8%) ANTIFUNGALS Denial 1
3952 PODIATRIST, PRIMARY MEDICINE Ciclopirox (topical solution
8%) ANTIFUNGALS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox (topical solution
8%) ANTIFUNGALS Denial 1
3963 DERMATOLOGY Ciclopirox (topical solution 8%) ANTIFUNGALS
Approval 1
3963 FAMILY PRACTICE Ciclopirox (topical solution 8%)
ANTIFUNGALS Denial 4
3951 FAMILY PRACTICE CICLOPIROX 8% SOL ANTIFUNGALS Approval
1
3951 DERMATOLOGY Ciclopirox 8% EX SOLN ANTIFUNGALS Approval
1
3951 PODIATRIST, PRIMARY MEDICINE Ciclopirox 8% EX SOLN
ANTIFUNGALS No Response 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox 8% EX SOLN
ANTIFUNGALS Approval 1
-
10
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 FAMILY PRACTICE Ciclopirox 8% EX SOLN ANTIFUNGALS No
Response 2
3952 PODIATRIST, PRIMARY MEDICINE Ciclopirox 8% EX SOLN
ANTIFUNGALS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox 8% EX SOLN
ANTIFUNGALS No Response 1
3963 FAMILY PRACTICE Ciclopirox 8% EX SOLN ANTIFUNGALS No
Response 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ciclopirox Kit 8% ANTIFUNGALS
Denial 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Ciclopirox Kit 8%
ANTIFUNGALS Denial 1
3956 INTERNAL MEDICINE cinacalcet SYSTEMIC HORMONAL AGENTS
Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin)
DERMATOLOGICAL AGENTS No Response 1
3951 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin)
DERMATOLOGICAL AGENTS Approval 1
3952 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3952 FAMILY PRACTICE Claravis (isotretinoin) DERMATOLOGICAL
AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis (isotretinoin)
DERMATOLOGICAL AGENTS Approval 1
3956 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin)
DERMATOLOGICAL AGENTS Approval 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Claravis (isotretinoin)
DERMATOLOGICAL AGENTS Denial 1
3963 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS
Approval 1
3963 DERMATOLOGY Claravis (isotretinoin) DERMATOLOGICAL AGENTS
Denial 1
3963 EMERGENCY MEDICINE Claravis (isotretinoin) DERMATOLOGICAL
AGENTS Approval 1
3963 EMERGENCY MEDICINE Claravis (isotretinoin) DERMATOLOGICAL
AGENTS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Claravis 20MG OR CAPS
DERMATOLOGICAL AGENTS No Response 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3951 DERMATOLOGY CLARAVIS 30MG CAP DERMATOLOGICAL AGENTS
Approval 1
3951 DERMATOLOGY Claravis 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 3
3952 DERMATOLOGY Claravis 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 30MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3961 DERMATOLOGY Claravis 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3963 DERMATOLOGY Claravis 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 3
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 30MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Claravis 40MG OR CAPS
DERMATOLOGICAL AGENTS No Response 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Claravis 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3956 DERMATOLOGY Claravis 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Claravis 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 2
3963 DERMATOLOGY Claravis 40MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
-
11
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 NURSE PRACTITIONER, UNSPECIFIED Claravis 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Clindamycin-Tretinoin 1.2-0.025% EX GEL
DERMATOLOGICAL AGENTS Approval 1
3956 NEUROLOGY Clobazam ANTICONVULSANTS Denial 3
3956 NEUROLOGY, PEDIATRIC Clobazam ANTICONVULSANTS Denial 1
3956 NEUROLOGY cloBAZam 10MG OR TABS ANTICONVULSANTS Approval
1
3951 GASTROENTEROLOGY Codeine Sulfate 30mg Tablets NARCOTIC
ANALGESICS Denial 1
3952 FAMILY PRACTICE Continuous Blood Glucose DEVICES Denial
2
3963 PRESCRIBER SPECIALTY, UNKNOWN Continuous Blood Glucose
DEVICES Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Continuous Blood Glucose
DEVICES Denial 1
3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES Approval
1
3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES Denial
1
3963 INTERNAL MEDICINE Continuous Blood Glucose DEVICES No
Response 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Continuous Blood Glucose
DEVICES Denial 1
3956 NEUROLOGY Copaxone 20mg MULTIPLE SCLEROSIS Approval 1
3956 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS No Response
1
3961 NURSE PRACTITIONER, FAMILY HEALTH Copaxone 40mg MULTIPLE
SCLEROSIS Approval 1
3963 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Approval 1
3963 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Denial 1
3963 DERMATOLOGY Cordran (Brand Only) (flurandrenolide) Tape
DERMATOLOGICAL AGENTS Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3951 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS
Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3951 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval
1
3952 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3952 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval
1
3956 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3956 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1
3956 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS
Approval 1
3956 INTERNAL MEDICINE Cosentyx IMMUNOSUPPRESSIVES/DMARDS No
Response 2
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Denial 1
3956 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Approval
4
3956 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS No Response
1
3961 DERMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS Approval 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Cosentyx
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3963 FAMILY PRACTICE Cosentyx IMMUNOSUPPRESSIVES/DMARDS No
Response 1
-
12
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 RHEUMATOLOGY Cosentyx IMMUNOSUPPRESSIVES/DMARDS Denial
1
3956 RHEUMATOLOGY Cosentyx Sensoready Pen 150MG/ML SC SOAJ
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3951 NURSE PRACTITIONER, FAMILY HEALTH dalfampridine ER MULTIPLE
SCLEROSIS Approval 2
3956 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Approval
1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED dalfampridine ER MULTIPLE
SCLEROSIS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH Daliresp (roflumilast)
RESPIRATORY AGENTS Approval 1
3956 PULMONARY DISEASES Daliresp 250MCG OR TABS RESPIRATORY
AGENTS Approval 2
3956 FAMILY PRACTICE Daliresp 500MCG OR TABS RESPIRATORY AGENTS
Approval 1
3956 NURSE PRACTITIONER, UNSPECIFIED Daliresp 500MCG OR TABS
RESPIRATORY AGENTS Approval 1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Daliresp 500MCG OR TABS
RESPIRATORY AGENTS Approval 1
3961 PULMONARY DISEASES Daliresp 500MCG OR TABS RESPIRATORY
AGENTS Approval 1
3952 PEDIATRICS Denavir (penciclovir) ANTIVIRALS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Denavir (penciclovir)
ANTIVIRALS Approval 1
3963 FAMILY PRACTICE Denavir (penciclovir) ANTIVIRALS Approval
1
3963 FAMILY PRACTICE Denavir (penciclovir) ANTIVIRALS No
Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Depo-Testosterone 200MG/ML IM
SOLN ANDROGENS Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Depo-Testosterone 200MG/ML IM
SOLN ANDROGENS Approval 1
3952 EMERGENCY MEDICINE Depo-Testosterone 200MG/ML IM SOLN
ANDROGENS Approval 1
3956 FAMILY PRACTICE Depo-Testosterone 200MG/ML IM SOLN
ANDROGENS No Response 1
3963 FAMILY PRACTICE Depo-Testosterone 200MG/ML IM SOLN
ANDROGENS Approval 3
3963 INTERNAL MEDICINE Depo-Testosterone 200MG/ML IM SOLN
ANDROGENS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Depo-Testosterone
200MG/ML IM SOLN ANDROGENS No Response 1
3963 NURSE PRACTITIONER, UNSPECIFIED Depo-Testosterone 200MG/ML
IM SOLN ANDROGENS Approval 1
3963 UROLOGY Depo-Testosterone 200MG/ML IM SOLN ANDROGENS No
Response 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Derma-Smoothe F/S (Brand
Only) (fluocinolone) DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Desonate 0.05% EX GEL DERMATOLOGICAL AGENTS
Approval 1
3954 GENERAL PRACTICE DEXCOM G6 EACH DEVICES Approval 1
3963 FAMILY PRACTICE DEXCOM G6 EACH DEVICES Approval 1
3963 PEDIATRICS DEXCOM G6 SENSOR DEVICES Denial 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dexcom G6 Sensor DEVICES
Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Sensor XX MISC
DEVICES Approval 1
3951 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES Approval 1
3952 ENDOCRINOLOGY, DIABETES & METABOLISM Dexcom G6 Sensor
XX MISC DEVICES Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Sensor XX MISC
DEVICES No Response 1
3963 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Dexcom G6 Sensor
XX MISC DEVICES Denial 1
3963 ENDOCRINOLOGY, PEDIATRIC Dexcom G6 Sensor XX MISC DEVICES
Approval 1
3963 FAMILY PRACTICE Dexcom G6 Sensor XX MISC DEVICES Approval
1
-
13
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES Approval 1
3963 PEDIATRICS Dexcom G6 Sensor XX MISC DEVICES No Response
1
3963 PHYSICIAN, ENDOCRINOLOGY Dexcom G6 Sensor XX MISC DEVICES
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Dexcom G6 Transmitter XX MISC
DEVICES Approval 2
3963 FAMILY PRACTICE Dexcom G6 Transmitter XX MISC DEVICES
Approval 1
3956 FAMILY PRACTICE Dexilant 60MG OR CPDR GASTROINTESTINAL
AGENTS No Response 1
3956 OPHTHALMOLOGY Dexilant 60MG OR CPDR GASTROINTESTINAL AGENTS
No Response 1
3956 PSYCHIATRY Dexmethylphenidate HCl 10MG OR TABS CNS
STIMULANTS Approval 1
3963 ORTHOPEDIC SURGERY diclofenac 1 % topical gel (VOLTAREN)
NON-NARCOTIC ANALGESICS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Approval 4
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Denial 2
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS No Response 1
3951 ANESTHESIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 5
3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 2
3951 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS No Response 1
3951 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS No Response 1
3951 NURSE PRACTITIONER, ADULT HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS Approval 1
3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS Denial 2
3951 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS No Response 1
3951 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS No Response 1
3951 PHYSICIAN, GERIATRIC MEDICINE Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Denial 1
3951 PODIATRIST, PRIMARY MEDICINE Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Denial 1
3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1%
TD GEL NON-NARCOTIC ANALGESICS Approval 1
3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1%
TD GEL NON-NARCOTIC ANALGESICS Denial 1
3951 PODIATRIST, SURGERY, FOOT & ANKLE Diclofenac Sodium 1%
TD GEL NON-NARCOTIC ANALGESICS No Response 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Approval 3
3952 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS No Response 1
3952 CARDIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3952 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 4
3952 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3952 NURSE PRACTITIONER, ADULT HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS Approval 1
3952 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 2
3952 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 1
3952 PEDIATRICS Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3952 PEDIATRICS Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 1
-
14
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 PODIATRIST, UNSPECIFIED Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Approval 1
3954 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Approval 7
3963 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium 1% TD GEL
NON-NARCOTIC ANALGESICS Denial 2
3963 ANESTHESIOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 2
3963 EMERGENCY MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 1
3963 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 17
3963 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 2
3963 FAMILY PRACTICE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS No Response 4
3963 INTERNAL MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 3
3963 NEUROLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS Approval 3
3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS Denial 3
3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium 1% TD
GEL NON-NARCOTIC ANALGESICS No Response 3
3963 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 5
3963 ORTHOPEDIC SURGERY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 1
3963 PAIN MEDICINE Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Denial 1
3963 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Diclofenac Sodium 1% TD GEL NON-NARCOTIC ANALGESICS
Denial 1
3963 RHEUMATOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS Approval 4
3963 RHEUMATOLOGY Diclofenac Sodium 1% TD GEL NON-NARCOTIC
ANALGESICS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS Approval 4
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS Denial 3
3951 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS No Response 1
3951 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 2
3951 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 3
3951 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 2
3951 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Approval 2
3951 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 3
3951 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 1
3951 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 1
3951 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Approval 1
3951 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC ANALGESICS
Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS Denial 3
3952 ANESTHESIOLOGY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
-
15
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 1
3952 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 3
3952 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 1
3952 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Approval 1
3952 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS Approval 3
3963 PRESCRIBER SPECIALTY, UNKNOWN Diclofenac Sodium Topical Gel
1% NON-NARCOTIC ANALGESICS Denial 10
3963 ANESTHESIOLOGY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 2
3963 EMERGENCY MEDICINE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3963 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 7
3963 FAMILY PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 5
3963 GENERAL PRACTICE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 1
3963 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 1
3963 INTERNAL MEDICINE Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 4
3963 NEUROLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC
ANALGESICS Denial 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 4
3963 NURSE PRACTITIONER, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 2
3963 ORTHOPEDIC SURGERY Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 1
3963 PEDIATRICS Diclofenac Sodium Topical Gel 1% NON-NARCOTIC
ANALGESICS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Diclofenac Sodium Topical
Gel 1% NON-NARCOTIC ANALGESICS Denial 1
3963 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Approval 2
3963 PODIATRIST, UNSPECIFIED Diclofenac Sodium Topical Gel 1%
NON-NARCOTIC ANALGESICS Denial 1
3963 PSYCHIATRY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC
ANALGESICS Approval 1
3963 RHEUMATOLOGY Diclofenac Sodium Topical Gel 1% NON-NARCOTIC
ANALGESICS Denial 1
3956 INTERNAL MEDICINE Dificid (fidaxomicin) ANTI-INFECTIVES
Approval 1
3961 INFECTIOUS DISEASES Dificid (fidaxomicin) ANTI-INFECTIVES
Approval 1
3961 FAMILY PRACTICE Dificid 200MG OR TABS ANTI-INFECTIVES
Approval 1
3951 CARDIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1
3956 CARDIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 1
3956 NURSE PRACTITIONER, ACUTE CARE dofetilide CARDIOVASCULAR
AGENTS Approval 1
3956 NURSE PRACTITIONER, UNSPECIFIED dofetilide CARDIOVASCULAR
AGENTS Approval 1
3956 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide
CARDIOVASCULAR AGENTS Approval 1
3961 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide
CARDIOVASCULAR AGENTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Doryx (doxycycline hyclate)
ANTI-INFECTIVES Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Doryx 50MG OR TBEC
ANTI-INFECTIVES Approval 1
3963 DERMATOLOGY Doxycycline ANTI-INFECTIVES Denial 1
-
16
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline 40MG OR CPDR
ANTI-INFECTIVES Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline 40MG OR CPDR
ANTI-INFECTIVES No Response 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Doxycycline 40MG OR CPDR
ANTI-INFECTIVES Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline Hyclate 100MG OR
TBEC ANTI-INFECTIVES Approval 1
3963 DERMATOLOGY Doxycycline Hyclate 150MG OR TBEC
ANTI-INFECTIVES Approval 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Doxycycline Hyclate 200MG OR
TBEC ANTI-INFECTIVES Approval 1
3963 ANESTHESIOLOGY Dronabinol ANTINAUSEANTS Denial 1
3963 HEMATOLOGY & ONCOLOGY Dronabinol ANTINAUSEANTS Approval
1
3963 PEDIATRICS Dronabinol ANTINAUSEANTS Denial 1
3963 FAMILY PRACTICE Dronabinol 10MG OR CAPS ANTINAUSEANTS
Denial 1
3951 HEMATOLOGY & ONCOLOGY Dronabinol 2.5MG OR CAPS
ANTINAUSEANTS Approval 1
3963 INFECTIOUS DISEASES Dronabinol 2.5MG OR CAPS ANTINAUSEANTS
Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Duobrii 0.01-0.045% EX LOTN
DERMATOLOGICAL AGENTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Duobrii 0.01-0.045% EX LOTN
DERMATOLOGICAL AGENTS Approval 2
3963 DERMATOLOGY Duobrii 0.01-0.045% EX LOTN DERMATOLOGICAL
AGENTS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Duobrii 0.01-0.045% EX
LOTN DERMATOLOGICAL AGENTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1
3951 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS
Denial 1
3951 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL
AGENTS No Response 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2
3952 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1
3952 NURSE PRACTITIONER, FAMILY HEALTH Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1
3952 NURSE PRACTITIONER, FAMILY HEALTH Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1
3952 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS
Denial 1
3954 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1
3954 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 4
3963 ALLERGY & IMMUNOLOGY Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1
3963 ALLERGY & IMMUNOLOGY Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1
3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS
Approval 2
3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS
Denial 1
3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS
No Response 4
3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2
-
17
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL
AGENTS Approval 1
3951 DERMATOLOGY Dupixent 300MG/2ML SC SOSY
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2
3963 ALLERGY & IMMUNOLOGY Dupixent 300MG/2ML SC SOSY
IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2
3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC
SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1
3963 FAMILY PRACTICE Duragesic-75 75MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Ecoza 1% EX FOAM
ANTIFUNGALS Approval 1
3951 FAMILY PRACTICE Eletriptan NON-NARCOTIC ANALGESICS Approval
1
3963 PRESCRIBER SPECIALTY, UNKNOWN Elidel (pimecrolimus)
DERMATOLOGICAL AGENTS Denial 2
3951 DERMATOLOGY Elidel 1% EX CREA DERMATOLOGICAL AGENTS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Elidel 1% EX CREA
DERMATOLOGICAL AGENTS Approval 3
3963 DERMATOLOGY Elidel 1% EX CREA DERMATOLOGICAL AGENTS
Approval 1
3963 INTERNAL MEDICINE Elidel 1% EX CREA DERMATOLOGICAL AGENTS
Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH Elidel 1% EX CREA
DERMATOLOGICAL AGENTS Approval 3
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Elidel 1% EX CREA
DERMATOLOGICAL AGENTS Approval 1
3956 OBSTETRICS & GYNECOLOGY Eligard 22.5mg HORMONES/HORMONE
MODIFIERS Denial 1
3956 OBSTETRICS & GYNECOLOGY Eligard 22.5MG SC KIT
HORMONES/HORMONE MODIFIERS No Response 1
3963 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Embeda 20-0.8MG OR CPCR NARCOTIC ANALGESICS Approval
1
3951 ANESTHESIOLOGY Embeda 30-1.2MG OR CPCR NARCOTIC ANALGESICS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Emsam (selegiline)
ANTIDEPRESSANTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Approval 2
3951 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
1
3951 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3951 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
5
3951 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response
2
3952 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
1
3956 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Approval 2
3956 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3956 INTERNAL MEDICINE Enbrel IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3956 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
7
3956 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 1
3956 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response
1
3961 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3961 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Denial 1
3961 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
2
3963 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Denial 1
-
18
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS Denial 3
3963 PRESCRIBER SPECIALTY, UNKNOWN Enbrel
IMMUNOSUPPRESSIVES/DMARDS No Response 2
3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 1
3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval 1
3963 DERMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS No Response
1
3963 FAMILY PRACTICE Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
2
3963 NURSE PRACTITIONER, UNSPECIFIED Enbrel
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3963 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Approval
3
3963 RHEUMATOLOGY Enbrel IMMUNOSUPPRESSIVES/DMARDS Denial 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Epidiolex DERMATOLOGICAL
AGENTS No Response 1
3963 NEUROLOGY, PEDIATRIC Epidiolex DERMATOLOGICAL AGENTS Denial
2
3956 DERMATOLOGY Erivedge ANTINEOPLASTICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Esbriet RESPIRATORY AGENTS
Denial 1
3956 PULMONARY DISEASES Esbriet RESPIRATORY AGENTS Approval
1
3951 OBSTETRICS & GYNECOLOGY Estradiol 0.1MG/GM VA CREA
HORMONES/HORMONE MODIFIERS No Response 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Exelderm 1% EX CREA
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Fabior 0.1% EX FOAM DERMATOLOGICAL AGENTS
Approval 1
3963 INTERNAL MEDICINE Fabior 0.1% EX FOAM DERMATOLOGICAL AGENTS
Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Fabior 0.1% EX FOAM
DERMATOLOGICAL AGENTS Approval 1
3956 FAMILY PRACTICE Fentanyl 100 mcg TD Patch NARCOTIC
ANALGESICS Approval 1
3951 FAMILY PRACTICE fentaNYL 100MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3951 ANESTHESIOLOGY fentaNYL 12MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN fentaNYL 25MCG/HR TD PT72
NARCOTIC ANALGESICS Approval 1
3956 HEMATOLOGY & ONCOLOGY fentaNYL 25MCG/HR TD PT72
NARCOTIC ANALGESICS Approval 1
3956 FAMILY PRACTICE Fentanyl 50 mcg TD Patch NARCOTIC
ANALGESICS Approval 1
3961 ANESTHESIOLOGY Fentanyl 50 mcg TD Patch NARCOTIC ANALGESICS
Approval 1
3963 INTERNAL MEDICINE FENTANYL 50MCG/HR DIS NARCOTIC ANALGESICS
No Response 1
3952 FAMILY PRACTICE fentaNYL 50MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN fentaNYL 50MCG/HR TD PT72
NARCOTIC ANALGESICS Approval 1
3956 INTERNAL MEDICINE fentaNYL 50MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3963 ANESTHESIOLOGY fentaNYL 50MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3963 INTERNAL MEDICINE fentaNYL 50MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 2
3963 ORTHOPEDIC SURGERY fentaNYL 50MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
3951 ANESTHESIOLOGY Fentanyl 50mcg/hr Transdermal Patch NARCOTIC
ANALGESICS Denial 1
3951 INTERNAL MEDICINE Fentanyl 50mcg/hr Transdermal Patch
NARCOTIC ANALGESICS Approval 1
3956 PALLIATIVE MEDICINE Fentanyl 75 mcg TD Patch NARCOTIC
ANALGESICS Approval 1
3956 INTERNAL MEDICINE fentaNYL 75MCG/HR TD PT72 NARCOTIC
ANALGESICS Approval 1
-
19
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 ANESTHESIOLOGY Fentanyl 75mcg/hr Transdermal Patch NARCOTIC
ANALGESICS Approval 1
3952 ANESTHESIOLOGY Fentanyl 75mcg/hr Transdermal Patch NARCOTIC
ANALGESICS Denial 1
3963 FAMILY PRACTICE Fluocinonide 0.05% Cream DERMATOLOGICAL
AGENTS Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS No
Response 1
3951 FAMILY PRACTICE Forteo OSTEOPOROSIS AGENTS Approval 1
3951 FAMILY PRACTICE Forteo OSTEOPOROSIS AGENTS No Response
1
3951 INTERNAL MEDICINE Forteo OSTEOPOROSIS AGENTS Approval 1
3951 RHEUMATOLOGY Forteo OSTEOPOROSIS AGENTS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS No
Response 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Forteo OSTEOPOROSIS AGENTS
Approval 1
3963 OBSTETRICS & GYNECOLOGY Forteo OSTEOPOROSIS AGENTS No
Response 1
3963 FAMILY PRACTICE Freestyle Continuous Blood Glucose System
Sensor DIABETIC SUPPLIES Denial 1
3963 NURSE PRACTITIONER, WOMEN’S HEALTH FREESTYLE LIBRE 10 DAY
SENS KIT DIABETIC SUPPLIES Approval 1
3951 FAMILY PRACTICE FreeStyle Libre 14 Day Reader XX DEVI
DEVICES Denial 1
3963 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14
Day Reader XX DEVI DEVICES No Response 1
3963 FAMILY PRACTICE FreeStyle Libre 14 Day Reader XX DEVI
DEVICES Approval 1
3951 FAMILY PRACTICE FreeStyle Libre 14 Day Sensor XX MISC
DEVICES Denial 1
3952 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14
Day Sensor XX MISC DEVICES Approval 1
3952 REGISTERED NURSE, UNSPECIFIED FreeStyle Libre 14 Day Sensor
XX MISC DEVICES Denial 1
3963 ENDOCRINOLOGY, DIABETES & METABOLISM FreeStyle Libre 14
Day Sensor XX MISC DEVICES Denial 1
3963 FAMILY PRACTICE FreeStyle Libre 14 Day Sensor XX MISC
DEVICES Denial 1
3963 INTERNAL MEDICINE FreeStyle Libre 14 Day Sensor XX MISC
DEVICES Denial 1
3963 INTERNAL MEDICINE FreeStyle Libre 14 Day Sensor XX MISC
DEVICES No Response 1
3952 FAMILY PRACTICE FreeStyle Libre Continuous Blood Glucose
Monitoring System DIABETIC SUPPLIES Denial 1
3951 PHYSICIAN, ENDOCRINOLOGY Freestyle Libre Continuous Blood
glucose Reader DIABETIC SUPPLIES Denial 1
3952 INTERNAL MEDICINE Freestyle Libre Reader DEVICES Denial
1
3963 FAMILY PRACTICE FreeStyle Libre Reader XX DEVI DEVICES
Denial 1
3951 ENDOCRINOLOGY, PEDIATRIC FreeStyle Libre Sensor System XX
MISC DEVICES Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Genotropin HORMONES/HORMONE
MODIFIERS Approval 1
3952 ENDOCRINOLOGY, PEDIATRIC Genotropin 12MG SC SOLR
HORMONES/HORMONE MODIFIERS Denial 1
3956 NEUROLOGY Gilenya MULTIPLE SCLEROSIS Denial 1
3961 NEUROLOGY Gilenya MULTIPLE SCLEROSIS Approval 1
3961 NURSE PRACTITIONER, FAMILY HEALTH glatiramer acetate 20mg
MULTIPLE SCLEROSIS Approval 1
3951 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS
Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN glatiramer acetate 40mg
MULTIPLE SCLEROSIS No Response 2
3952 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS
Approval 1
-
20
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3952 NURSE PRACTITIONER, FAMILY HEALTH glatiramer acetate 40mg
MULTIPLE SCLEROSIS Approval 1
3956 FAMILY PRACTICE glatiramer acetate 40mg MULTIPLE SCLEROSIS
Approval 1
3956 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS
Approval 1
3956 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS No
Response 1
3963 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS
Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED glatiramer acetate 40mg
MULTIPLE SCLEROSIS Approval 1
3961 NURSE PRACTITIONER, FAMILY HEALTH Glatopa MULTIPLE
SCLEROSIS No Response 1
3963 NEUROLOGY Glatopa MULTIPLE SCLEROSIS Approval 1
3951 HEMATOLOGY Gleevec ANTINEOPLASTICS No Response 1
3963 HEMATOLOGY & ONCOLOGY Gleevec ANTINEOPLASTICS Approval
1
3963 HEMATOLOGY & ONCOLOGY Gleevec ANTINEOPLASTICS No
Response 1
3963 ALLERGY & IMMUNOLOGY Grastek 2800BAU SL SUBL ALLERGENS
Approval 1
3963 DERMATOLOGY Halog 0.1% EX OINT DERMATOLOGICAL AGENTS
Approval 1
3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Hizentra
IMMUNOGLOBULINS Approval 1
3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Hizentra
IMMUNOGLOBULINS Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Humatrope HORMONES/HORMONE
MODIFIERS Approval 2
3951 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE
MODIFIERS Approval 1
3951 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE
MODIFIERS Denial 1
3952 ENDOCRINOLOGY, PEDIATRIC Humatrope HORMONES/HORMONE
MODIFIERS Denial 1
3961 PRESCRIBER SPECIALTY, UNKNOWN Humatrope HORMONES/HORMONE
MODIFIERS Approval 2
3961 PEDIATRICS Humatrope HORMONES/HORMONE MODIFIERS Approval
1
3961 PEDIATRICS Humatrope HORMONES/HORMONE MODIFIERS No Response
2
3963 PRESCRIBER SPECIALTY, UNKNOWN Humatrope HORMONES/HORMONE
MODIFIERS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 4
3951 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 4
3951 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 4
3951 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response
1
3951 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
1
3951 GASTROENTEROLOGY, PEDIATRIC Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 2
3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
2
3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 2
3951 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response
1
3952 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 4
3952 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
1
3952 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3952 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
2
-
21
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 6
3956 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Denial 2
3956 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 8
3956 DENTIST, UNSPECIFIED Humira IMMUNOSUPPRESSIVES/DMARDS
Approval 1
3956 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 3
3956 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 1
3956 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS Approval
1
3956 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 3
3956 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
2
3956 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3956 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS Approval
2
3956 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 2
3956 NURSE PRACTITIONER, FAMILY HEALTH Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3956 NURSE PRACTITIONER, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3956 NURSE PRACTITIONER, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 2
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3956 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
17
3956 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 1
3956 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response
3
3961 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3961 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3961 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 1
3961 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS Approval
1
3961 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3961 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3961 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
4
3963 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 10
3963 PRESCRIBER SPECIALTY, UNKNOWN Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 6
3963 DERMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval 7
3963 FAMILY PRACTICE Humira IMMUNOSUPPRESSIVES/DMARDS Approval
1
3963 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
8
3963 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial
1
3963 GASTROENTEROLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3963 GASTROENTEROLOGY, PEDIATRIC Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3963 GASTROENTEROLOGY, PEDIATRIC Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3963 INTERNAL MEDICINE Humira IMMUNOSUPPRESSIVES/DMARDS Denial
1
3963 NURSE PRACTITIONER, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 2
-
22
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 NURSE PRACTITIONER, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Humira
IMMUNOSUPPRESSIVES/DMARDS Approval 1
3963 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Approval
10
3963 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS Denial 2
3963 RHEUMATOLOGY Humira IMMUNOSUPPRESSIVES/DMARDS No Response
1
3956 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg/0.8 mL
subcutaneous syringe kit IMMUNOSUPPRESSIVES/DMARDS Approval 1
3961 RHEUMATOLOGY Humira Pen 40MG/0.4ML SC PNKT
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3956 DERMATOLOGY Humira Pen 40MG/0.8ML SC PNKT
IMMUNOSUPPRESSIVES/DMARDS No Response 1
3963 NURSE PRACTITIONER, UNSPECIFIED Humira Pen-Ps/UV/Adol HS
Start 80 MG/0.8ML &40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS
No Response 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 10-325 mg
NARCOTIC ANALGESICS Approval 3
3956 CARDIOLOGY Hydroco/APAP Tab 10-325 mg NARCOTIC ANALGESICS
Approval 1
3956 FAMILY PRACTICE Hydroco/APAP Tab 10-325 mg NARCOTIC
ANALGESICS Approval 2
3956 GENERAL PRACTICE Hydroco/APAP Tab 10-325 mg NARCOTIC
ANALGESICS Approval 2
3956 HEMATOLOGY & ONCOLOGY Hydroco/APAP Tab 10-325 mg
NARCOTIC ANALGESICS Approval 1
3956 INTERNAL MEDICINE Hydroco/APAP Tab 10-325 mg NARCOTIC
ANALGESICS Approval 1
3956 INTERNAL MEDICINE Hydroco/APAP Tab 10-325 mg NARCOTIC
ANALGESICS Denial 1
3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 10-325 mg NARCOTIC
ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 5-325 mg
NARCOTIC ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 5-325 mg
NARCOTIC ANALGESICS No Response 1
3956 FAMILY PRACTICE Hydroco/APAP Tab 5-325 mg NARCOTIC
ANALGESICS Approval 3
3956 INTERNAL MEDICINE Hydroco/APAP Tab 5-325 mg NARCOTIC
ANALGESICS Approval 2
3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 5-325 mg
NARCOTIC ANALGESICS No Response 1
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Hydroco/APAP Tab 5-325 mg NARCOTIC ANALGESICS Approval
1
3963 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 5-325 mg
NARCOTIC ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Hydroco/APAP Tab 7.5-325 mg
NARCOTIC ANALGESICS No Response 1
3956 ANESTHESIOLOGY Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS Approval 2
3956 FAMILY PRACTICE Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS No Response 3
3956 INTERNAL MEDICINE Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS Approval 1
3956 NEUROLOGICAL SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS No Response 1
3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 7.5-325
mg NARCOTIC ANALGESICS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH Hydroco/APAP Tab 7.5-325
mg NARCOTIC ANALGESICS No Response 1
3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS Approval 1
3956 ORTHOPEDIC SURGERY Hydroco/APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS No Response 2
3963 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone 10
mg-acetaminophen 325 mg tablet (NORCO 10-325) NARCOTIC ANALGESICS
No Response 1
3952 FAMILY PRACTICE HYDROcodone 5 mg-acetaminophen 325 mg
tablet (NORCO) NARCOTIC ANALGESICS Approval 1
-
23
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3951 FAMILY PRACTICE HYDROcodone 7.5 mg-acetaminophen 325 mg
tablet (NORCO) NARCOTIC ANALGESICS Approval 1
3952 CLINICAL NURSE SPECIALIST, ADULT HEALTH HYDROcodone 7.5
mg-acetaminophen 325 mg tablet (NORCO) NARCOTIC ANALGESICS No
Response 1
3963 NEUROLOGICAL SURGERY HYDROcodone 7.5 mg-acetaminophen 325
mg tablet (NORCO) NARCOTIC ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
10-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 2
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 10-325 MG Oral
Tablet NARCOTIC ANALGESICS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
10-325MG OR TABS NARCOTIC ANALGESICS Approval 1
3951 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3952 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 ANESTHESIOLOGY HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 5
3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS No Response 1
3956 GENERAL PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 10-325MG OR
TABS NARCOTIC ANALGESICS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
10-325MG OR TABS NARCOTIC ANALGESICS No Response 2
3956 PHYSICIAN ASSISTANT, UNSPECIFIED HYDROcodone-Acetaminophen
10-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY HYDROcodone-Acetaminophen 10-325MG OR TABS NARCOTIC
ANALGESICS Approval 1
3961 ANESTHESIOLOGY HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
10-325MG OR TABS NARCOTIC ANALGESICS Approval 4
3963 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 5
3963 FAMILY PRACTICE HYDROcodone-Acetaminophen 10-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3963 INTERNAL MEDICINE HYDROcodone-Acetaminophen 10-325MG OR
TABS NARCOTIC ANALGESICS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
10-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3963 ORTHOPEDIC SURGERY HYDROcodone-Acetaminophen 10-325MG OR
TABS NARCOTIC ANALGESICS Approval 1
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 5-325 MG Oral
Tablet NARCOTIC ANALGESICS No Response 1
3956 ORTHOPEDIC SURGERY hydrocodone-acetaminophen 5-325 mg
tablet NARCOTIC ANALGESICS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
5-325MG OR TABS NARCOTIC ANALGESICS Approval 1
3951 CLINICAL NURSE SPECIALIST, ACUTE CARE
HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
5-325MG OR TABS NARCOTIC ANALGESICS Approval 3
3956 ANESTHESIOLOGY HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS Approval 4
3956 EMERGENCY MEDICINE HYDROcodone-Acetaminophen 5-325MG OR
TABS NARCOTIC ANALGESICS Approval 1
3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS Approval 5
3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS No Response 1
3956 HEMATOLOGY & ONCOLOGY HYDROcodone-Acetaminophen 5-325MG
OR TABS NARCOTIC ANALGESICS Approval 1
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
5-325MG OR TABS NARCOTIC ANALGESICS Approval 2
-
24
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PAIN MEDICINE HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 PHYSICIAN, ANESTHESIOLOGY, PAIN MANAGEMENT
HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC ANALGESICS
Approval 1
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY HYDROcodone-Acetaminophen 5-325MG OR TABS NARCOTIC
ANALGESICS Approval 1
3963 ANESTHESIOLOGY HYDROcodone-Acetaminophen 5-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3963 EMERGENCY MEDICINE HYDROcodone-Acetaminophen 5-325MG OR
TABS NARCOTIC ANALGESICS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
5-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
7.5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 1
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 7.5-325 MG Oral
Tablet NARCOTIC ANALGESICS No Response 2
3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
7.5-325 MG Oral Tablet NARCOTIC ANALGESICS No Response 2
3951 ANESTHESIOLOGY HYDROcodone-Acetaminophen 7.5-325MG OR TABS
NARCOTIC ANALGESICS Approval 1
3951 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS
NARCOTIC ANALGESICS Denial 1
3952 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone-Acetaminophen
7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN HYDROcodone-Acetaminophen
7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3956 ANESTHESIOLOGY HYDROcodone-Acetaminophen 7.5-325MG OR TABS
NARCOTIC ANALGESICS Approval 4
3956 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS
NARCOTIC ANALGESICS Approval 2
3956 INTERNAL MEDICINE HYDROcodone-Acetaminophen 7.5-325MG OR
TABS NARCOTIC ANALGESICS No Response 1
3956 NURSE PRACTITIONER, FAMILY HEALTH HYDROcodone-Acetaminophen
7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3956 NURSE PRACTITIONER, UNSPECIFIED HYDROcodone-Acetaminophen
7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 1
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC
ANALGESICS Approval 1
3956 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY HYDROcodone-Acetaminophen 7.5-325MG OR TABS NARCOTIC
ANALGESICS No Response 1
3956 PHYSICIAN, SURGERY, GENERAL HYDROcodone-Acetaminophen
7.5-325MG OR TABS NARCOTIC ANALGESICS Approval 2
3963 FAMILY PRACTICE HYDROcodone-Acetaminophen 7.5-325MG OR TABS
NARCOTIC ANALGESICS Approval 2
3951 FAMILY PRACTICE Hydrocodone-APAP Tab 10-325 mg NARCOTIC
ANALGESICS Approval 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Hydrocodone-APAP Tab 10-325
mg NARCOTIC ANALGESICS Approval 1
3951 PHYSICIAN, PHYSICAL MEDICINE & REHABILITATION /
PHYS-IATRY Hydrocodone-APAP Tab 5-325 mg NARCOTIC ANALGESICS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Hydrocodone-APAP Tab 5-325 mg
NARCOTIC ANALGESICS Approval 1
3963 INTERNAL MEDICINE Hydrocodone-APAP Tab 5-325 mg NARCOTIC
ANALGESICS Approval 1
3963 FAMILY PRACTICE Hydrocodone-APAP Tab 7.5-325 mg NARCOTIC
ANALGESICS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN HYDROmorphone HCl 2MG OR TABS
NARCOTIC ANALGESICS Approval 1
3956 NURSE PRACTITIONER, UNSPECIFIED Hydromorphone Tab 2 mg
NARCOTIC ANALGESICS Approval 1
3956 PHYSICIAN, SURGERY, GENERAL Hydromorphone Tab 2 mg NARCOTIC
ANALGESICS Approval 1
3963 ALLERGY & IMMUNOLOGY HyQvia IMMUNOGLOBULINS Approval
1
3963 FAMILY PRACTICE Hysingla ER 30MG OR T24A NARCOTIC
ANALGESICS Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS No
Response 1
-
25
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 HEMATOLOGY Ibrance ANTINEOPLASTICS Approval 1
3956 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Approval
1
3956 MEDICAL ONCOLOGY Ibrance ANTINEOPLASTICS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ibrance ANTINEOPLASTICS No
Response 1
3951 HEMATOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2
3951 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Approval 2
3952 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Approval 2
3952 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Denial 2
3956 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Approval 2
3956 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Denial 2
3961 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
No Response 2
3963 HEMATOLOGY imatinib mesylate ANTINEOPLASTICS Denial 2
3963 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
Approval 2
3963 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS
No Response 2
3952 PRESCRIBER SPECIALTY, UNKNOWN Imbruvica ANTINEOPLASTICS
Approval 1
3952 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS
Approval 1
3952 PHYSICIAN, ONCOLOGY, MEDICAL Imbruvica ANTINEOPLASTICS
Approval 1
3956 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS
Approval 1
3956 MEDICAL ONCOLOGY Imbruvica ANTINEOPLASTICS Approval 1
3956 PHYSICIAN, ONCOLOGY, MEDICAL Imbruvica ANTINEOPLASTICS
Approval 1
3961 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS
Approval 1
3961 PHYSICIAN, ONCOLOGY, MEDICAL Imbruvica ANTINEOPLASTICS
Approval 1
3963 HEMATOLOGY Imbruvica ANTINEOPLASTICS Approval 1
3963 HEMATOLOGY & ONCOLOGY Imbruvica ANTINEOPLASTICS No
Response 1
3956 MEDICAL ONCOLOGY Imbruvica 140MG OR CAPS ANTINEOPLASTICS No
Response 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Increlex HORMONES/HORMONE
MODIFIERS No Response 1
3963 PEDIATRICS Increlex HORMONES/HORMONE MODIFIERS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Inlyta ANTINEOPLASTICS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Inlyta ANTINEOPLASTICS
Approval 1
3956 NURSE PRACTITIONER, ACUTE CARE Inlyta ANTINEOPLASTICS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Inlyta ANTINEOPLASTICS
Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Isotretinoin DERMATOLOGICAL
AGENTS Approval 1
3951 PHYSICIAN ASSISTANT, UNSPECIFIED Isotretinoin
DERMATOLOGICAL AGENTS Approval 1
3963 DERMATOLOGY Isotretinoin DERMATOLOGICAL AGENTS Approval
1
3954 FAMILY PRACTICE ISOtretinoin 10MG OR CAPS DERMATOLOGICAL
AGENTS Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN isotretinoin 20 mg capsule
DERMATOLOGICAL AGENTS Approval 1
-
26
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PRESCRIBER SPECIALTY, UNKNOWN ISOtretinoin 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3956 NURSE PRACTITIONER, FAMILY HEALTH ISOtretinoin 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED ISOtretinoin 20MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN ISOtretinoin 30MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3956 DERMATOLOGY ISOtretinoin 30MG OR CAPS DERMATOLOGICAL AGENTS
Approval 1
3952 PRESCRIBER SPECIALTY, UNKNOWN ISOtretinoin 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3952 PHYSICIAN ASSISTANT, UNSPECIFIED ISOtretinoin 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN ISOtretinoin 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 2
3963 FAMILY PRACTICE ISOtretinoin 40MG OR CAPS DERMATOLOGICAL
AGENTS Approval 1
3963 NURSE PRACTITIONER, FAMILY HEALTH ISOtretinoin 40MG OR CAPS
DERMATOLOGICAL AGENTS Approval 3
3952 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole 100MG OR CAPS
ANTIFUNGALS Approval 1
3956 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS No
Response 2
3956 NURSE PRACTITIONER, FAMILY HEALTH Itraconazole 100MG OR
CAPS ANTIFUNGALS Approval 1
3961 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole 100MG OR CAPS
ANTIFUNGALS Approval 1
3961 PULMONARY DISEASES Itraconazole 100MG OR CAPS ANTIFUNGALS
Approval 1
3963 FAMILY PRACTICE Itraconazole 100MG OR CAPS ANTIFUNGALS
Approval 1
3951 INFECTIOUS DISEASES Itraconazole Capsules ANTIFUNGALS
Approval 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole Capsules
ANTIFUNGALS Denial 2
3956 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Approval
2
3956 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Denial
2
3956 INFECTIOUS DISEASES Itraconazole Capsules ANTIFUNGALS
Approval 1
3956 OTOLARYNGOLOGY Itraconazole Capsules ANTIFUNGALS Denial
1
3956 PODIATRIST, UNSPECIFIED Itraconazole Capsules ANTIFUNGALS
Approval 1
3956 PULMONARY DISEASES Itraconazole Capsules ANTIFUNGALS
Approval 1
3961 FAMILY MEDICINE Itraconazole Capsules ANTIFUNGALS Approval
1
3961 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Denial
1
3961 NURSE PRACTITIONER, FAMILY HEALTH Itraconazole Capsules
ANTIFUNGALS Denial 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Itraconazole Capsules
ANTIFUNGALS Approval 1
3963 FAMILY PRACTICE Itraconazole Capsules ANTIFUNGALS Approval
1
3963 INFECTIOUS DISEASES Itraconazole Capsules ANTIFUNGALS
Approval 1
3963 INTERNAL MEDICINE Itraconazole Capsules ANTIFUNGALS
Approval 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Ivermectin 1% EX CREA
ANTIPARASITIC AGENTS Approval 1
3951 DERMATOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS
Approval 2
3952 DERMATOPATHOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS
Approval 1
3952 FAMILY PRACTICE Ivermectin 1% EX CREA ANTIPARASITIC AGENTS
Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Ivermectin 1% EX CREA
ANTIPARASITIC AGENTS Approval 2
-
27
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3963 DERMATOLOGY Ivermectin 1% EX CREA ANTIPARASITIC AGENTS
Approval 2
3963 NURSE PRACTITIONER, FAMILY HEALTH Ivermectin 1% EX CREA
ANTIPARASITIC AGENTS Approval 1
3963 PHYSICIAN ASSISTANT, UNSPECIFIED Ivermectin 1% EX CREA
ANTIPARASITIC AGENTS Approval 1
3956 INTERNAL MEDICINE Jakafi ANTINEOPLASTICS Approval 1
3963 PHYSICIAN, ONCOLOGY, MEDICAL Jakafi ANTINEOPLASTICS Denial
1
3963 DERMATOLOGY Jublia 10 % topical solution with applicator
ANTIFUNGALS No Response 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Jublia 10% EX SOLN
ANTIFUNGALS Approval 1
3952 DERMATOLOGY Jublia 10% EX SOLN ANTIFUNGALS Approval 1
3952 FAMILY PRACTICE Jublia 10% EX SOLN ANTIFUNGALS Approval
1
3956 PRESCRIBER SPECIALTY, UNKNOWN Jublia 10% EX SOLN
ANTIFUNGALS Approval 1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Jublia 10% EX SOLN
ANTIFUNGALS Approval 1
3961 DERMATOLOGY Jublia 10% EX SOLN ANTIFUNGALS Approval 1
3963 PRESCRIBER SPECIALTY, UNKNOWN Jublia 10% EX SOLN
ANTIFUNGALS Approval 1
3963 DERMATOLOGY Jublia 10% EX SOLN ANTIFUNGALS Approval 1
3963 FAMILY PRACTICE Jublia 10% EX SOLN ANTIFUNGALS Approval
1
3951 PRESCRIBER SPECIALTY, UNKNOWN Jynarque HORMONES/HORMONE
MODIFIERS Approval 1
3951 NEPHROLOGY / RENAL MEDICINE Jynarque HORMONES/HORMONE
MODIFIERS Denial 1
3951 PRESCRIBER SPECIALTY, UNKNOWN Kerydin (tavaborole topical
solution) ANTIFUNGALS Denial 1
3963 DERMATOLOGY Kerydin (tavaborole topical solution)
ANTIFUNGALS Denial 2
3963 PRESCRIBER SPECIALTY, UNKNOWN Kerydin 5% EX SOLN
ANTIFUNGALS Approval 1
3963 DERMATOLOGY Kerydin 5% EX SOLN ANTIFUNGALS Approval 2
3963 DERMATOLOGY Kerydin 5% EX SOLN ANTIFUNGALS No Response
3
3963 PODIATRIST, SURGERY, FOOT & ANKLE Kerydin 5% EX SOLN
ANTIFUNGALS Approval 1
3956 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval
1
3963 INTERNAL MEDICINE Kevzara IMMUNOSUPPRESSIVES/DMARDS
Approval 1
3963 INTERNAL MEDICINE Kevzara IMMUNOSUPPRESSIVES/DMARDS No
Response 1
3963 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval
3
3956 HEMATOLOGY & ONCOLOGY Kisqali ANTINEOPLASTICS Approval
1
3963 PULMONOLOGY, PEDIATRIC Kitabis Pak ANTI-INFECTIVES Approval
1
3956 PHYSICIAN ASSISTANT, UNSPECIFIED Kuvan METABOLIC AGENTS
Approval 1
3956 INTERNAL MEDICINE Lenvima ANTINEOPLASTICS Denial 1
3963 ONCOLOGY, GYNECOLOGIC Lenvima ANTINEOPLASTICS Denial 2
3951 FAMILY PRACTICE Lidocaine 5% EX PTCH NON-NARCOTIC
ANALGESICS Denial 1
3952 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH
NON-NARCOTIC ANALGESICS Denial 5
3952 PAIN MEDICINE Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS
Approval 1
3952 PSYCHIATRY Lidocaine 5% EX PTCH NON-NARCOTIC ANALGESICS
Denial 1
3956 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH
NON-NARCOTIC ANALGESICS Approval 1
-
28
Carrier Prescriber Primary Specialty Description Drug SPECIALTY
CODE DESCRIPTION Decision Count
3956 PRESCRIBER SPECIALTY, UNKNOWN Lidocaine 5% EX PTCH
NON-NARCOTIC ANALGES