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2013 Prior Authorization

Covered Drugs for Dual Eligible Individuals

Theraputic Categories:

  • Antibiotics - Ketocanazole Oral Tablets, Special Formlations
  • Anti-Infectives
  • Biologics - Botulinum toxins, Hematopoetic, Immunomodulating, Replacement Therapy, Respiratory, Skeletal
  • Cardiovascular - Antihypertensives, Antiplatelet, Antihyperlipidemics, Clonidine Products, Revatio
  • Central Nervous System/Behavioral Health  - ADHD & Narcolepsy, Alzheimer's, Antidepressants, Anti-Migraine, Anxiolytic/Hypnotic, Atypical Antipsychotics, Fibromyalgia, Multiple Sclerosis, Narcotic Analgesics, Parkinson's, Restless Leg Syndrome, Requip XL/Mirapex ER, Smoking Cessation, Substance Abuse Treatment
  • Diabetes/Endocrine - Diabetic Medications, Erythropoietin Stimulating Agents, Growth Hormone, Testosterone
  • Gastro-Intestinal - Amitiza, Anti-emetic, Anti-Ulcer
  • Genitourinary System - Benign Prostatic Hyperplasia (BPH), Bladder Control Drugs
  • Ocular/Otic - Ocular Allergy, Opthalmic Anti-Infective/Steroid, Ophthalmic Glaucoma, Otic Anti-Infective 
  • Respiratory - Asthma & COPD Inhalation Medications, Antihistamines, Leukotriene Modifiers, Nasal Allergy Sprays, Synagis, Xolair
  • Skeletal System - Amrix & Fexmid, Bisphosonates, Forteo, Gout, NSAIDs, Skeletal Muscle Relaxants, Soma
  • Topical - Antifungal, Elidel/Protopic, Lidoderm Patch, Pediculicides, Topical Antibiotic Medications, Topical Corticosteroids
Last Modified on Dec 14, 2022
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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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