Injectable Medications Requiring Prior Authorization

Injectable Medication/Infusion Reference Guide

TriWest Prior Authorization Drug List Effective 12/1/09 Effective 08/1/09 Effective 01/1/09 Effective 10/1/08-12/31/08 Effective 04/15/08-9/30/08 Effective 04/01/08 to 04/14/08 Effective 10/01/07 to 03/31/08 Effective 07/01/07 to 09/30/07 Effective 04/01/07 to 06/30/07 Effective 10/1/06 to 03/31/07