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- is a way to keep HealthCare cost in check. It will make sure that the service or drug that the physician is requesting is truly medically necessary.
- it will also ensure that the service isn't being duplicate.
PA CRITERIA EXCULUSION - state if the drug must or must not be used with other medications. REQUIRED MEDICAL INFORMATION - Documentation like diagnosis or test results needed for coverage. AGE RESTRICTIONS - Limits or allows use based on the patient's age. PRESCIBER RESTRICTIONS - Requires the drug to be prescribed by a specialist.