Materials

Acute Care Materials
• Formularies:

Acute Care PDL
Acute Care PDL Quick Reference

• Forms:

Acute Care US Script Prior Auth Form
Acute Request for Authorization Form

• Prior Authorization Lists:

Acute Care Prior Authorization List

Long Term Care Materials

• Formularies:

Long Term Care PDL Quick Reference
Long Term Care PDL

• Forms:

LongTermCare-US Script Prior Authorization Form
LTC Request for Authorization Form

• Prior Authorization Lists:

Long Term Care – Prior Authorization List


Medicare Advantage Materials

• Formularies:

Abridged Medicare Advantage Formulary
Comprehensive Medicare Advantage Formulary
Comprehensive Medicare Advantage Formulary – Spanish

• Forms:

Advantage Request for Authorization Form
Advantage-US Script Prior Authorization Form

• Prior Authorization Lists:

Advantage – Prior Authorization List

Advantage by Bridgeway Health Solutions Prior Authorization Guidelines

Medicare Advantage 2010 Materials

Medicare Advantage by BHS 2010 Maintenance Drug Program
Medicare Advantage by BHS 2010 Comprehensive Formulary
Medicare Advantage by BHS 2010 Abridged Formulary
Medicare Advantage by BCHP 2010 Quantity Limits
Medicare Advantage by BHS 2010 Prior Authorization Guidelines

Pregnancy/Newborn

• Prior Authorization Lists:

Pregnancy Notification Form
Newborn Notification Form

Caremark

• Prior Authorization Lists:

CareMark Enrollment Form

RSV-Synagis

• Prior Authorization Lists:

2009-2010 RSV-Synagis Enrollment Form

Smoking Cessation

Smoking Cessation PA Protocol