Apple Health (Medicaid) drug coverage criteria

Use this page to find drug policies and request forms.

For information on billing and rates, the Apple Health preferred drug list, and expedited authorization codes, please visit the Prescription Drug Program on our provider billing guide and rates page.

Coverage for

Policies and FAQs

Forms

Androgenic Agents  
Antiasthmatic Monoclonal Antibodies  
Antibiotics  
Antidiabetics  
Antihyperlipidemics  
Antiparasitics  
Antivirals  
Atopic Dermatitis Agents  
Brands with Generic Equivalents  
Cardiovascular Agents  

Chronic GI Motility Agents

 
Cytokine and CAM Agents  
Endocrine and Metabolic Agents: Metabolic Modifiers  
Growth Hormone Agents  
Hematopoietic Agents  
Migraine Products  

Medication Treatment for Substance Abuse Disorders (SUDs)

Methadone  
Opioids
Ophthalmics  
Progesterones  

Proton Pump Inhibitors (PPIs)

 

Psychotherapeutic and Neurological Agents – MISC : Multiple Sclerosis Agents  
Psychotherapeutic and Neurological Agents – MISC : Transthyretin Amyloidosis Agents  
Pulmonary Arterial Hypertension (PAH) Agents  
Pulmonary Fibrosis Agents  
Respiratory Agents – MISC  

Spinraza

 

Transmucosal Fentanyl Products