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Delaware Medical Assistance Portal Document Repository

NameSizeModified
File-Adobe-Acrobat-Gif163File.Adobe.Acrobat2016\12\file_20161208_144849_yeI_0.resources0True{defaultview}False17 hydroxyprogesterone caproate (Makena)031012312/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif164File.Adobe.Acrobat2016\12\file_20161208_144849_hRTV_0.resources0True{defaultview}FalseADHD therapy and CNS stimulants038029212/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif165File.Adobe.Acrobat2016\12\file_20161208_144849_aeN_0.resources0True{defaultview}FalseAlprazolam Alternative (Niravam, Xanax XR)09235512/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif167File.Adobe.Acrobat2016\12\file_20161208_144849_nvmymG_0.resources0True{defaultview}FalseAlzheimers Agents - Cholinesterase Inhibitors022161212/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif166File.Adobe.Acrobat2016\12\file_20161208_144849_XTPN_0.resources0True{defaultview}FalseAmpyra08088512/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif169File.Adobe.Acrobat2016\12\file_20161208_144849_amS_0.resources0True{defaultview}FalseAntidepressants pediatric022391612/8/2016 2:48:50 PM
File-Adobe-Acrobat-Gif168File.Adobe.Acrobat2016\12\file_20161208_144849_Uxy_0.resources0True{defaultview}FalseAntiobesity drug08650412/8/2016 2:48:50 PM
Collection-Gif446Collection1True{defaultview}FalseArchive050127466/30/2017 4:46:09 PM
File-Adobe-Acrobat-Gif170File.Adobe.Acrobat2016\12\file_20161208_144849_MLqxfx_0.resources0True{defaultview}FalseBecapelemin (Regranex)07729912/8/2016 2:48:51 PM
File-Adobe-Acrobat-Gif171File.Adobe.Acrobat2016\12\file_20161208_144849_wTaHX_0.resources0True{defaultview}FalseBone Resorption Suppression and Related Agents017658012/8/2016 2:48:51 PM
File-Adobe-Acrobat-Gif174File.Adobe.Acrobat2016\12\file_20161208_144849_EvD_0.resources0True{defaultview}FalseButorpahanol NS (Stadol NS)010178312/8/2016 2:48:51 PM
File-Adobe-Acrobat-Gif177File.Adobe.Acrobat2016\12\file_20161208_144849_DrUoF_0.resources0True{defaultview}FalseCarisoprodol (Soma)031049412/8/2016 2:48:52 PM
File-Adobe-Acrobat-Gif175File.Adobe.Acrobat2016\12\file_20161208_144849_WisQkQ_0.resources0True{defaultview}FalseCelecoxib valdecoxib (Celebrex)013827612/8/2016 2:48:51 PM
File-Adobe-Acrobat-Gif176File.Adobe.Acrobat2016\12\file_20161208_144849_AvbAi_0.resources0True{defaultview}FalseCinacalcet (Sensipar)08103712/8/2016 2:48:51 PM
File-Adobe-Acrobat-Gif1029File.Adobe.Acrobat2020\03\file_20200309_121748_pwchqc_0.resources0True{defaultview}FalseDupixent Prior Authorization Form01227033/9/2020 12:17:47 PM
File-Adobe-Acrobat-Gif178File.Adobe.Acrobat2016\12\file_20161208_144849_fsCuf_0.resources0True{defaultview}FalseEpidermal Growth Factor (Iressa and Tarceva)017914912/8/2016 2:48:52 PM
File-Adobe-Acrobat-Gif179File.Adobe.Acrobat2016\12\file_20161208_144849_gOQFYE_0.resources0True{defaultview}FalseEpoetin Alpha (Epogen, Procrit, Aranesp)014324912/8/2016 2:48:52 PM
File-Adobe-Acrobat-Gif180File.Adobe.Acrobat2016\12\file_20161208_144849_fRRjF_0.resources0True{defaultview}FalseFentanyl transmucosal (Actiq) and Buccal (Fentora)07764412/8/2016 2:48:52 PM
File-Adobe-Acrobat-Gif181File.Adobe.Acrobat2016\12\file_20161208_145156_Tbib_0.resources0True{defaultview}FalseGrowth Hormone014720612/8/2016 2:51:56 PM
File-Adobe-Acrobat-Gif182File.Adobe.Acrobat2016\12\file_20161208_145156_Obzatu_0.resources0True{defaultview}FalseHemophilia Factor017258912/8/2016 2:51:56 PM
File-Adobe-Acrobat-Gif536File.Adobe.Acrobat2017\01\file_20170111_210634_Abk_0.resources0True{defaultview}FalseHepatitis C Agents07289751/11/2017 9:06:33 PM
File-Adobe-Acrobat-Gif183File.Adobe.Acrobat2018\05\file_20180501_152546_JqXags_0.resources0True{defaultview}FalseHigh-Dose Narcotics and Long- and Short-Acting Opioids02012515/1/2018 3:25:45 PM
File-Adobe-Acrobat-Gif185File.Adobe.Acrobat2016\12\file_20161208_145156_WWh_0.resources0True{defaultview}FalseHome Infusion Therapy020302512/8/2016 2:51:57 PM
File-Adobe-Acrobat-Gif186File.Adobe.Acrobat2016\12\file_20161208_145156_TpX_0.resources0True{defaultview}FalseImmunomodulators for Atopic Dermatitis017510712/8/2016 2:51:57 PM
File-Adobe-Acrobat-Gif188File.Adobe.Acrobat2016\12\file_20161208_145156_hrnbz_0.resources0True{defaultview}FalseIncretin Mimetics023318412/8/2016 2:51:57 PM
File-Adobe-Acrobat-Gif187File.Adobe.Acrobat2016\12\file_20161208_145156_QMgNK_0.resources0True{defaultview}FalseIsotretinoin (Accutane, Clarvavis)014103912/8/2016 2:51:57 PM
File-Adobe-Acrobat-Gif548File.Adobe.Acrobat2017\01\file_20170111_210734_OOsZds_0.resources0True{defaultview}FalseLevalbuterol (Xopenex respules)01875741/11/2017 9:07:34 PM
File-Adobe-Acrobat-Gif547File.Adobe.Acrobat2017\01\file_20170111_210734_ShJC_0.resources0True{defaultview}FalseLidocaine Topical Patch (Lidoderm)01558251/11/2017 9:07:33 PM
File-Adobe-Acrobat-Gif192File.Adobe.Acrobat2016\12\file_20161208_145156_AiKIiE_0.resources0True{defaultview}FalseLinezolid (Zyvox)012296612/8/2016 2:51:58 PM
File-Adobe-Acrobat-Gif193File.Adobe.Acrobat2016\12\file_20161208_145156_fxzI_0.resources0True{defaultview}FalseLong-Acting Beta Agonist Corticosteroid Inhalant Combination Medications018631412/8/2016 2:51:58 PM
File-Adobe-Acrobat-Gif194File.Adobe.Acrobat2018\04\file_20180410_113046_BuL_0.resources0True{defaultview}FalseLong-Acting Injectable Atypical Antipsychotics0704364/10/2018 11:30:47 AM
File-Adobe-Acrobat-Gif196File.Adobe.Acrobat2016\12\file_20161208_145156_Jzmo_0.resources0True{defaultview}FalseLubiprostone (Amitiza) and Linaclotide (Linzess)028053912/8/2016 2:51:58 PM
File-Adobe-Acrobat-Gif195File.Adobe.Acrobat2016\12\file_20161208_145156_NZzi_0.resources0True{defaultview}FalseMaraviorac (Selzentry)013504212/8/2016 2:51:58 PM
File-Adobe-Acrobat-Gif197File.Adobe.Acrobat2016\12\file_20161208_145156_tYT_0.resources0True{defaultview}FalseMegestrol (Megace), Oxandrolone (Oxandrin), Dronabinol (Marinol)07969712/8/2016 2:51:59 PM
File-Adobe-Acrobat-Gif199File.Adobe.Acrobat2016\12\file_20161208_145156_TetLz_0.resources0True{defaultview}FalseModafinil (Provigil) and Armodafinil (Nuvigil)024006212/8/2016 2:51:59 PM
File-Adobe-Acrobat-Gif535File.Adobe.Acrobat2017\01\file_20170111_210803_gmn_0.resources0True{defaultview}FalseNaltrexone HCL IM (Vivitrol)02533681/11/2017 9:08:03 PM
File-Adobe-Acrobat-Gif200File.Adobe.Acrobat2016\12\file_20161208_145156_JBeCG_0.resources0True{defaultview}FalseNicotine Replacement and Varenicline (Chantix)014340012/8/2016 2:51:59 PM
File-Adobe-Acrobat-Gif201File.Adobe.Acrobat2016\12\file_20161208_145156_jMCng_0.resources0True{defaultview}FalsePalivizumab Injection (Synagis)019359812/8/2016 2:51:59 PM
File-Adobe-Acrobat-Gif205File.Adobe.Acrobat2016\12\file_20161208_145156_LBv_0.resources0True{defaultview}FalsePCSK9 Inhibitors050268712/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif202File.Adobe.Acrobat2016\12\file_20161208_145156_tZlgD_0.resources0True{defaultview}FalsePDL, Quantity Limit, Medical Necessity023478112/8/2016 2:51:59 PM
File-Adobe-Acrobat-Gif203File.Adobe.Acrobat2016\12\file_20161208_145156_gbPQq_0.resources0True{defaultview}FalsePhosphorous Binders07881212/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif204File.Adobe.Acrobat2016\12\file_20161208_145156_PIIKxP_0.resources0True{defaultview}FalsePramlintide Acetate (Symlin)07929812/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif206File.Adobe.Acrobat2016\12\file_20161208_145156_FcA_0.resources0True{defaultview}FalsePregabalin (Lyrica), Milnacipran HCL (Savella)013570812/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif207File.Adobe.Acrobat2016\12\file_20161208_145156_Pmr_0.resources0True{defaultview}FalseProton Pump Inhibitors016013212/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif208File.Adobe.Acrobat2016\12\file_20161208_145156_YFc_0.resources0True{defaultview}FalsePulmonary Arterial Hypertension Agents013478212/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif209File.Adobe.Acrobat2016\12\file_20161208_145156_SsCB_0.resources0True{defaultview}FalseTestosterone Supplementation037398312/8/2016 2:52:00 PM
File-Adobe-Acrobat-Gif210File.Adobe.Acrobat2016\12\file_20161208_145156_qZPuO_0.resources0True{defaultview}Falsexenazine031304312/8/2016 2:52:01 PM