Heart Failure protocol (Read Code G580)
Preferred status agents for ACEI and Fixed-Dose-Combination-Product (FDCP)-ACEI/HCTZ include ... “Non-preferred” status ACEI, FDCP-ACEI/HCTZ, FDCP-CCB/ACEI, ARB, and FDCP-ARB/HCTZ include ... requesting a prior authorization for a drug on the PDL or requesting a prior authorization for an antipsychotic medication should contact the Evidence ... ................
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