Drug: ACCUTANE - Magellan Health Services || TennCare Portal

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CRITERIA FOR REVIEW<br />

COMMITTEE VOTE:<br />

APPROVED DISAPPROVED APPROVED with MODIFICATION<br />

Page 14 of 14<br />

August 13, 2013 Tennessee PAC

CRITERIA FOR REVIEW COMMITTEE VOTE: APPROVED DISAPPROVED APPROVED with MODIFICATION Page 14 of 14 August 13, 2013 Tennessee PAC