BCCDT-2 – Covered Drugs for All Groups
These drugs will deny with NCPDP 75 – Prior Authorization Required: MD Call 410-767-4787 FOR PA Drug Code Drug Name Comments W3B Antifungal Agents P4B Bone Form, Stim Agents Parathy P4L Bone Ossification Suppression Agent D4K Gastric Acid Secretion Reducers N1B Hemantinics, Other M9K Heparin Preparations N1C Leukocyte (Wbc) Stimulants M9L ... ................
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