services requiring prior authorization - Oxford Health Plans
services requiring prior authorization - Oxford Health Plans
services requiring prior authorization - Oxford Health Plans
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Clinical Revlimid® (Lenalidomide) 10/01/2013<br />
Clinical Rhinoplasty, Septoplasty and Repair of Vestibular Stenosis 07/01/2013<br />
Clinical Rituximab (Rituxan) for Non Cancer Related Indications 07/01/2013<br />
Clinical Routine Foot Care 01/01/2014<br />
S<br />
Clinical Sandostatin LAR Depot (Octreotide Acetate) 02/15/2013<br />
Clinical Sandostatin Subcutaneous Formulation (Octreotide Acetate) 02/15/2013<br />
Clinical Sedative Hypnotic Agents 01/01/2014<br />
Clinical Selzentry (Maraviroc) 05/15/2013<br />
Clinical Sensory Integration Therapy 03/01/2013<br />
Clinical Shoulder Replacement Surgery (Arthoplasty) 01/01/2014<br />
Clinical Signifor (Pasireotide Diaspartate) 05/15/2013<br />
Clinical Sodium Hyaluronate 08/01/2013<br />
Clinical Sprycel ® (Dasatinib) 01/01/2014<br />
Clinical Standing Systems 09/01/2013<br />
Clinical Stelara (Ustekinumab) 08/01/2013<br />
Clinical<br />
Stribild TM (Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil<br />
Fumarate)<br />
12/01/2013<br />
Clinical Stivarga ® (Regorafenib) 07/01/2013<br />
Clinical Subcutaneous Leuprolide Acetate 01/01/2014<br />
Clinical Surgical Treatment for Spine Pain 04/01/2013<br />
Clinical Surgical Treatment of Obstructive Sleep Apnea 06/01/2013<br />
Clinical Sutent ® (Sunitinib Malate) 10/01/2013<br />
Clinical Synagis (palivizumab) 10/01/2013<br />
Clinical Synarel® (Nafarelin Acetate) 11/01/2013<br />
T<br />
Clinical Tafinlar (Dabrafenib) 01/01/2014<br />
Clinical Tarceva ® (Erlotinib) 10/01/2013<br />
Clinical Tasigna ® (Nilotinib) 10/01/2013<br />
Clinical Temodar ® (Temozolomide) 09/01/2013<br />
Clinical Teriparatide (Forteo) 11/15/2012<br />
Clinical Thalomid ® (Thalidomide) 10/01/2013<br />
Clinical Thermal Capsulorrhaphy/Thermal Shrinkage Therapy 05/01/2013<br />
Clinical Thermography 05/01/2013<br />
Clinical<br />
Tobi Nebulizer Solution (Tobramycin Inhalation Solution) and Tobi ®<br />
Podhaler (Tobramycin Inhalation Powder)<br />
01/01/2014<br />
Clinical Topical Retinoids (Pharmaceutical Treatment of Acne) 01/01/2014<br />
Clinical Total Artificial Disc Replacement for Spine 01/01/2013<br />
Clinical Total Artificial Heart 10/01/2013<br />
Services Requiring Prior Authorization 8<br />
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