Qutenza

Fact Sheet: Product Overview - Qutenza

Qutenza® is indicated for the management of neuropathic pain associated with postherpetic neuralgia (PHN). A single, 1-hour, localized treatment can provide 3 months of relief from pain associated with postherpetic neuralgia (PHN). Qutenza is the first and only prescription-strength capsaicin product targeted to the nerves in the skin.

  Qutenza

MARYLAND PREFERRED DRUG LIST - Provider Synergies

NALGESICS Key: cc-Clinical criteria can be found at the link here ql- Quantity limits can be found at the link here All lowercase letters = generic product.

  Drug, Preferred, Lists, Maryland, Maryland preferred drug list

Medical Prior Authorization List - FirstCarolinaCare

8/03/15 Approved Version for 2016 PreAuth . Medical Prior Authorization List . Effective January 1, 2016 . For Members: The services, items and drugs listed below require a prior authorization in order to be covered. In-network providers must obtain authorization 48 …

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REQUEST FOR PRIOR AUTHORIZATION FAX (559) 224-2405 or …

REQUEST FOR PRIOR AUTHORIZATION FAX (559) 224-2405 or (559) 224-9746 PHONE (559) 228-5400 or (800) 652-2900 O Aqua Therapy O Intensity Modulated Radiation Therapy (IMRT)