Magellan Rx Management
C-II stimulant use in ADULTS age 18 yrs and older; Suboxone ... Narcolepsy diagnosis ICD-9 code(s) not found in AR Medicaid claim’s history will require a manual review process. ... 10 ml NO PA ACETASOL HC EAR DROPS ACETIC ACID/HYDROCORTISONE Manual Review PA SULF-PRED 10-0.25% EYE DROPS1 2 SULF-PRED 10-0.25% EYE DROPS 5 ml, 10 ml NO PA ... ................
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