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Prior Authorization Criteria

Your Medicare Part D formulary and Member Handbook/Evidence of Coverage (EOC) provides helpful information regarding questions about prior-authorization.

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

V

X

Z

Providence Health Plan is a health plan with a Medicare contract.

Revised 01/10
H9047_ADV 05_10