Procedures, programs, and drugs that require precertification
injectable suspension, J3490, J3590) — precertification required effective 3/15/2022 . Gattex (teduglutide) Givlaari (givosiran) – precertification for the drug and sit e of care required . Granulocyte-colony stimulating factors: Fulphila (pegfilgrastim-j …
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