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Rx Drug Formulary

Utilization Management Criteria
UMC-530-0001 Oral Contraceptives Prior Authorization
UMC-530-0002 Injectable Contraceptives Prior Authorization
UMC-530-0003 Lamisil (Oral) Prior Authorization
UMC-530-0004 Sporanox Prior Authorization
UMC-530-0005 Synagis Prior Authorization
UMC-530-0006 Enbrel Prior Authorization
UMC-530-0007 Thiazolidinedione
(Avandia, Actos and Avandamet) Step Therapy Criteria
UMC-530-0008 Pegylated Interferon (Peg-Intron and Pegasys) Prior Authorization
UMC-530-0009 Gleevac Prior Authorization Criteria
UMC-530-0011 Cerezyme Prior Authorization Criteria
UMC-530-0012 Growth Hormone Criteria
UMC-530-0015 Forteo Prior Authorization Criteria
UMC-530-0016 Humira Prior Authorization Criteria
UMC-530-0017 Vfend Prior Authorization Criteria
UMC-530-0018 Raptiva Prior Authorization Criteria
UMC-530-0019 Aldurazyme Prior Authorization
UMC-530-0020 Fabrazyme Prior Authorization
UMC-530-0021 Somavert Prior Authorization
UMC-530-0022 Anabolic Steroids Prior Authorization Criteria
UMC-530-0023 Kineret Prior Authorization Criteria
UMC-530-0024 Orfadin Prior Authorization Criteria
UMC-530-0025 Angiotensin-Converting Enzyme Inhibitors Step Therapy Criteria
UMC-530-0026 Leukotriene Pathway Inhibitors Step Therapy Criteria
UMC-530-0027 Proton Pump Inhibitors Step Therapy Criteria
UMC-530-0028 Retin A Prior Authorization Criteria
UMC-530-0029 Injectable Fertility Medication Criteria
UMC-530-0030 Lupron Prior Authorization Criteria
UMC-530-0031 Amevive Prior Authorization Criteria
UMC-530-0032 Xolair Prior Authorization Criteria
UMC-530-0033 Lyme Disease Prior Authorization Criteria
UMC-530-0034 Zavesca (Miglustat) Prior Authorization Criteria
UMC-530-0036 5HT3 Receptor Antagonists Anti-Emetics Step Criteria
UMC-530-0037 Bone Resorption Inhibitors Step Criteria
UMC-530-0038 HMG's ("Statins") Step Criteria
UMC-530-0039 Inflammatory Bowel Medications Step Criteria
UMC-530-0041 Macrolides Step Criteria
UMC-530-0042 Narcotic Analgesics Step Criteria
UMC-530-0043 Other Anti-Depressants Step Criteria
UMC-530-0044 Nasal Corticosteroids Step Criteria
UMC-530-0045 Pulmonary Anti-Inflammatories Step Criteria
UMC-530-0046 Short-Acting Bronchodilators Step Criteria
UMC-530-0047 Actiq Criteria
UMC-530-0048 Certain Drugs, Devices, and Biologicals
UMC-530-0049 Immunizations
UMC-530-0050 Revatio Criteria
UMC-530-0051 Symlin Criteria
UMC-530-0052 Byetta Criteria
UMC-530-0053 Naglazyme Criteria
UMC-530-0054 Selective Serontonin Reuptake Inhibitors Step Therapy Program
UMC-530-0055 Orencia Criteria
UMC-530-0056 Rituxan Criteria
UMC-530-0057 Lyrica Criteria
UMC-530-0058 Januvia Criteria
UMC-530-0059 Zolinza Criteria
UMC-530-0060 Boniva Criteria
UMC-530-0061 Cesamet Criteria
UMC-530-0062 Tykerb Criteria
UMC-530-0064 Ventavis Criteria
UMC-530-0065 Letairis Criteria
UMC-530-0066 Serotonin -Norepinephrine Reuptake Inhibitors Step Therapy
UMC-530-0067 Tasigna Criteria
UMC-530-0068 Tekturna and Tekturna HCT Criteria
UMC-530-0069 Reclast Infusion Criteria

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