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Welcome to the New Hampshire Medicaid Web site administered by Prime Therapeutics.
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GLP-1 Coverage Change
Effective January 1, 2026, New Hampshire Medicaid will no longer cover GLP-1 medications when prescribed solely for weight loss.
Oct 09, 2025New
Announcements
GLP-1 Coverage Change
Effective January 1, 2026, New Hampshire Medicaid will no longer cover GLP-1 medications when prescribed solely for weight loss.
Oct 09, 2025New
Brand over Generic Program
Effective 10/1/2025, the Brand over Generic Program for NH Medicaid will go into effect. Review the list to ensure proper reimbursement.
Aug 29, 2025
Announcements
Brand over Generic Program
Effective 10/1/2025, the Brand over Generic Program for NH Medicaid will go into effect. Review the list to ensure proper reimbursement.
Aug 29, 2025
PERM - Payment Error Rate Measurement
The PERM Audit is designed to measure improper payments in the Medicaid and CHIP programs, as required by the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Improvement Act or IPERA, and the Improper Payments Elimination and Recovery Improvement Act of 2012 IPERIA). The improper payment rates are based o nreviews of the Fee-for-Service (FFS), Medicaid payments to managed care, and eligibility components of Medicaid and CHIP in the year under review.
Beginning April 2025, the Center for Medicare and Medicaid Services (CMS) will be starting the New Hampshire PERM review of NH Medicaid claims and provider enrollment.
Jan 09, 2025
Announcements
PERM - Payment Error Rate Measurement
The PERM Audit is designed to measure improper payments in the Medicaid and CHIP programs, as required by the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Improvement Act or IPERA, and the Improper Payments Elimination and Recovery Improvement Act of 2012 IPERIA). The improper payment rates are based o nreviews of the Fee-for-Service (FFS), Medicaid payments to managed care, and eligibility components of Medicaid and CHIP in the year under review.
Beginning April 2025, the Center for Medicare and Medicaid Services (CMS) will be starting the New Hampshire PERM review of NH Medicaid claims and provider enrollment.
Jan 09, 2025
Preferred Drug List
New Hampshire Fee-for-Service Medicaid recently updated the preferred drug list. The current PDL is effective on 10/1/2025.
Aug 20, 2024
Announcements
Preferred Drug List
New Hampshire Fee-for-Service Medicaid recently updated the preferred drug list. The current PDL is effective on 10/1/2025.
Aug 20, 2024
Diabetic Supply Program
New Hampshire Fee-for-Service Medicaid recently updated the preferred diabetic supply list. It is effective 10/01/2025. View the preferred diabetic supply list .
Aug 19, 2024
Announcements
Diabetic Supply Program
New Hampshire Fee-for-Service Medicaid recently updated the preferred diabetic supply list. It is effective 10/01/2025. View the preferred diabetic supply list .
Aug 19, 2024
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Download
You can download the latest clinical criteria, PA forms, notifications, and plan guidance
CMS Tamper Resistant Prescription Pad Implementation.pdf
Mar 10, 2023 2:39:58 PM
CMS Tamper Resistant Prescription Pad Law_FAQ.pdf
Mar 10, 2023 2:09:54 PM
CMS Tamper Resistant Prescription Pad Law_Pharmacist Fact Sheet.pdf
Mar 10, 2023 2:08:23 PM
CMS Tamper Resistant Prescription Pad Law_Pharmacist Info.pdf
Mar 10, 2023 2:32:55 PM
CMS TRPP State Medicaid Director Letter.pdf
Mar 10, 2023 2:01:59 PM
Diabetic Supply Covered Items List.pdf
Mar 15, 2024 12:43:15 PM
NH DSP LIST 20240315.pdf
Oct 30, 2024 1:27:17 PM
NH DSP LIST 20241101.pdf
Sep 19, 2025 12:04:12 PM
DUR Agenda 03.20.2017.pdf
Mar 13, 2023 12:53:57 PM
DUR Agenda 05.12.2015.pdf
Mar 13, 2023 12:53:17 PM
DUR Agenda 05.20.2014.pdf
Mar 13, 2023 12:51:20 PM
DUR Agenda 05.31.2016.pdf
Mar 13, 2023 12:53:30 PM
DUR Agenda 10.11.2016.pdf
Mar 13, 2023 12:53:43 PM
DUR Agenda 10.24.2017.pdf
Mar 13, 2023 12:54:11 PM
New Hampshire Medicaid Standing Orders OTC COVID Test Kits and Naloxone.pdf
Jan 2, 2024 8:58:43 PM
Notification 01.01.2019 Diabetic Supply Program.pdf
Jan 2, 2024 8:34:02 PM
Notification 01.09.2015 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:59:26 PM
Notification 01.10.2017 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:57:03 PM
Notification 01.12.2021 Pharmacist Provider Enrollment.pdf
Jan 2, 2024 8:53:58 PM
Notification 01.21.2022 At-Home OTC COVID-19 Test Kits.pdf
Jan 2, 2024 8:56:25 PM
Notification 02.01.2022 Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:50:59 PM
Notification 03.12.2021 COVID-19 POS Billing Guidance update.pdf
Jan 2, 2024 8:55:24 PM
Notification 03.12.2021 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:55:05 PM
Notification 03.16.2020 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:37:21 PM
Notification 04.01.2021 COVID-19 POS Billing Guidance update.pdf
Jan 2, 2024 8:56:45 PM
Notification 04.02.2013 Change in TPL Field Length.pdf
Mar 13, 2023 1:03:53 PM
Notification 04.14.2022 At-Home OTC COVID-19 Test Kits.pdf
Jan 2, 2024 8:56:37 PM
Notification 04.22.2022 Diabetic Supply Program.pdf
Jan 2, 2024 8:35:16 PM
Notification 05.01.2019 Diabetic Supply Program.pdf
Jan 2, 2024 8:34:12 PM
Notification 05.17.2012 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 1:06:44 PM
Notification 05.26.2017 Updated Fiscal Impact Regarding Outpatient Drug Rule.pdf
Mar 13, 2023 12:55:54 PM
Notification 06.14.2019 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:36:36 PM
Notification 06.16.2017 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:48:28 PM
Notification 07.01.2019 Diabetic Supply Program.pdf
Jan 2, 2024 8:36:55 PM
Notification 07.03.2014 Changes to Copay.pdf
Mar 13, 2023 1:02:49 PM
Notification 07.06.2021 Non-Enrolled Prescriber Edit.pdf
Jan 2, 2024 8:55:46 PM
Notification 07.20.2016 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:57:42 PM
Notification 07.25.2012 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 1:06:09 PM
Notification 07.30.2019 340B Drug Discount Program_Effective 09.01.2019.pdf
Jan 2, 2024 8:34:25 PM
Notification 08.01.2014 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 1:02:16 PM
Notification 08.01.2019 PDL and Changes to Pharmacy Carve Out.pdf
Jan 2, 2024 8:37:38 PM
Notification 08.01.2022 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:40:04 PM
Notification 08.04.2013 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 1:03:14 PM
Notification 08.21.2018 Diabetic Supply Program.pdf
Jan 2, 2024 8:31:22 PM
Notification 08.22.2012 Diabetic Supply Program Update.pdf
Mar 13, 2023 1:05:44 PM
Notification 08.24.2015 PDL Transition.pdf
Mar 13, 2023 12:58:24 PM
Notification 08.24.2015 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:58:54 PM
Notification 09.01.2020 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:37:30 PM
Notification 09.01.2021 COVID-19 POS Billing Guidance.pdf
Jan 2, 2024 8:55:37 PM
Notification 09.07.2021 Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:55:57 PM
Notification 10.01.2019 Diabetic Supply Program.pdf
Jan 2, 2024 8:37:07 PM
Notification 10.01.2021 Diabetic Supply Program.pdf
Jan 2, 2024 8:35:30 PM
Notification 10.01.2022 Diabetic Supply Program.pdf
Jan 2, 2024 8:35:43 PM
Notification 10.08.2017 Emergency Drug Coverage Reminder.pdf
Mar 13, 2023 12:48:48 PM
Notification 10.30.2014 NHHPP Reinstatement of Co-Pays.pdf
Mar 13, 2023 1:01:19 PM
Notification 11.04.2021 Pediatric Influenza Vaccines through POS.pdf
Jan 2, 2024 8:55:15 PM
Notification 11.05.2020 340B Discount Program Effective_1.1.2021.pdf
Jan 2, 2024 8:34:45 PM
Notification 11.28.2018 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:36:46 PM
Notification 12.01.2021 Clinical PA Updates-Web Portal Info-Email.pdf
Jan 2, 2024 8:38:11 PM
Notification 12.05.2018 Diabetic Supply Program.pdf
Jan 2, 2024 8:32:06 PM
Notification 12.06.2012 Benzodiazepines and Barbiturates in Dual Eligibles.pdf
Mar 13, 2023 1:05:13 PM
Notification 12.07.2012 Diabetic Supply Program.pdf
Mar 13, 2023 1:04:32 PM
Notification 12.10.2020 Prescriber Soft Edit.pdf
Jan 2, 2024 8:51:24 PM
Notification 12.15.2017 PDL-Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 12:49:11 PM
Notification 12.23.2020 COVID-19 POS Billing Guidance.pdf
Jan 2, 2024 8:53:42 PM
Notification 12.31.2020 COVID-19 Billing Guidance update.pdf
Jan 2, 2024 8:40:36 PM
NHRx_PDL 2.3.2025.pdf
Jul 5, 2025 6:54:17 PM
NHRx_PDL_20240301..pdf
Mar 4, 2024 8:18:28 PM
Preferred Drug List - Effective 7.1.2023.pdf
Mar 4, 2024 8:18:57 PM
NHRx_PDL.pdf
Feb 3, 2025 2:59:31 PM
Trading Partners FTP Instructions.pdf
Oct 1, 2025 1:28:10 PM
Adenosine Triphosphate-Citrate Lyase Criteria.pdf
Jul 5, 2025 7:11:55 PM
Asthma-Allergy Immunomodulator Criteria.pdf
Oct 4, 2024 6:46:44 PM
Bowel Disorders.GI Motility, Chronic Criteria.pdf
Oct 4, 2024 6:47:14 PM
BPH Criteria.pdf
Dec 16, 2024 6:31:01 PM
Brand Name Multisource Drug Criteria.pdf
Jul 5, 2025 7:39:57 PM
Buprenorphine-Naloxone and Buprenorphine (Oral) Criteria.pdf
Jul 5, 2025 7:40:17 PM
Carisoprodol and Combination Criteria.pdf
Jul 5, 2025 7:41:58 PM
Casgevy Criteria.pdf
Mar 26, 2025 5:59:23 PM
CGRP Inhibitor Criteria.pdf
Dec 16, 2024 6:32:19 PM
Cholestatic Pruritus Criteria.pdf
Mar 26, 2025 6:01:23 PM
CNS Stimulants (ADHD.ADD) Criteria.pdf
Oct 4, 2024 6:51:20 PM
Codeine for Pediatric Use Criteria.pdf
Dec 16, 2024 6:32:41 PM
Convenience Kits Criteria.pdf
Dec 16, 2024 6:33:08 PM
Duchenne Muscular Dystrophy Agents Criteria.pdf
Oct 4, 2024 6:52:52 PM
Dupixent Criteria.pdf
Dec 16, 2024 6:33:43 PM
Elevidys Criteria.pdf
Mar 26, 2025 6:13:08 PM
Epidermolysis Bullosa Criteria.pdf
Mar 26, 2025 6:06:41 PM
GLP1 Agonist Criteria.pdf
Jul 5, 2025 7:13:14 PM
Hematopoietic Agent Criteria.pdf
Oct 4, 2024 6:54:38 PM
Hemophilia B Gene Criteria.pdf
Mar 26, 2025 6:09:05 PM
Hepatitis C Criteria.pdf
Dec 16, 2024 6:34:35 PM
Hetlioz Criteria.pdf
Jul 5, 2025 7:42:26 PM
Human Growth Hormones Criteria.pdf
Jul 5, 2025 7:13:41 PM
Hyaluronic Acid Derivatives Injection Criteria.pdf
Dec 16, 2024 6:45:17 PM
NH_Imcivree_Criteria_1.1.2026.pdf
Oct 9, 2025 7:32:08 PM
Juxtapid Criteria.pdf
Dec 16, 2024 6:45:51 PM
Kebilidi_Criteria.pdf
Jul 9, 2025 2:51:28 PM
Lenmeldy Criteria.pdf
Mar 26, 2025 6:09:41 PM
Long-acting Opioid Analgesic Criteria.pdf
Dec 16, 2024 6:46:10 PM
Lyfgenia Criteria.pdf
Mar 26, 2025 6:10:09 PM
NH_MACE_Wegovy_Criteria_1.1.2026.pdf
Oct 9, 2025 7:34:36 PM
NH_MASH_Criteria_1.1.2026.pdf
Oct 9, 2025 7:36:19 PM
Methadone Criteria.pdf
Jul 5, 2025 7:42:42 PM
Monoclonal Antibody for Alzheimer's Criteria.pdf
Dec 16, 2024 6:52:01 PM
Morphine Milligram Equivalent (MME) Criteria.pdf
Jul 5, 2025 7:43:58 PM
Movement Disorders Criteria.pdf
Dec 16, 2024 6:54:14 PM
New Drug Product Criteria.pdf
Jul 5, 2025 7:44:17 PM
NiemannPick_Criteria.pdf
Jul 9, 2025 2:51:58 PM
Oral Isotretinoin Criteria.pdf
Jul 5, 2025 7:45:52 PM
NH_OSA_Zepbound_Criteria_1.1.2026.pdf
Oct 9, 2025 7:35:22 PM
PCSK9 Criteria.pdf
Jul 5, 2025 7:14:03 PM
Primary Biliary Cholangitis Criteria.pdf
Mar 26, 2025 6:10:37 PM
Psychoactive Meds for Children under 5 Criteria.pdf
Jul 5, 2025 7:46:16 PM
Psychotropic Meds Duplicate Therapy Peds 6 and above Criteria.pdf
Jul 5, 2025 7:47:43 PM
Pulmonary Arterial Hypertension PDE-5 Criteria.pdf
Jul 5, 2025 7:15:27 PM
Rezdiffra Criteria.pdf
Mar 26, 2025 6:11:08 PM
Rho Kinase Inhibitor Criteria.pdf
Dec 16, 2024 6:56:09 PM
Roctavian Criteria.pdf
Jul 5, 2025 7:48:32 PM
Second-Line Antifungal Criteria.pdf
Jul 5, 2025 7:50:13 PM
Short-Acting Fentanyl Criteria.pdf
Oct 4, 2024 7:10:24 PM
Skin Disorders Criteria.pdf
Jul 5, 2025 7:16:30 PM
Skysona Criteria.pdf
Oct 4, 2024 7:11:17 PM
Spinal Muscular Atrophy Criteria.pdf
Oct 4, 2024 7:11:47 PM
Spravato Criteria.pdf
Jul 5, 2025 7:16:53 PM
Synagis Criteria.pdf
Jul 5, 2025 7:50:53 PM
Systemic Immunomodulator Criteria.pdf
Jul 5, 2025 7:17:15 PM
Topical Retinoids Criteria.pdf
Dec 16, 2024 6:59:52 PM
Verquvo Criteria.pdf
Jul 5, 2025 7:51:56 PM
Vuity Criteria.pdf
Jul 5, 2025 7:52:19 PM
Wakix Criteria.pdf
Mar 26, 2025 6:12:23 PM
NH_Weight_Management_Criteria 1.1.2026.pdf
Oct 9, 2025 7:37:17 PM
Weight Management Criteria.pdf
Oct 10, 2025 12:49:58 PM
Winrevair_Criteria.pdf
Jul 9, 2025 2:52:19 PM
Zurzuvae Criteria.pdf
Mar 26, 2025 6:11:54 PM
Zynteglo Criteria.pdf
Oct 4, 2024 7:17:03 PM
Agenda 03.12.2019.pdf
Mar 13, 2023 12:36:56 PM
Agenda 05.03.2018.pdf
Mar 13, 2023 12:38:33 PM
Agenda 06.02.2022.pdf
Mar 13, 2023 12:32:00 PM
Agenda 06.08.2021.pdf
Mar 13, 2023 12:35:30 PM
Agenda 06.19.2023.pdf
May 17, 2023 1:19:56 PM
Agenda 06.30.2020.pdf
Mar 13, 2023 12:35:02 PM
Agenda 09.27.2018.pdf
Mar 13, 2023 12:37:11 PM
202410_DUR_Board_Meeting_Agenda.pdf
Sep 12, 2024 12:09:59 PM
Agenda 10.28.2019.pdf
Mar 13, 2023 12:34:48 PM
Agenda 12.02.2021.pdf
Mar 13, 2023 12:34:33 PM
Agenda 12.13.2022.pdf
Mar 13, 2023 12:34:10 PM
Agenda 12.15.2020.pdf
Mar 13, 2023 12:35:17 PM
20250408_DUR_Board_Meeting_Agenda.pdf
Mar 26, 2025 3:33:00 PM
202405_DUR_Board_Meeting_Agenda.pdf
Apr 4, 2024 9:19:42 PM
20250923_DUR_Board_Meeting_Agenda.pdf
Aug 20, 2025 11:54:00 PM
Minutes 06.02.2022.pdf
Mar 13, 2023 12:32:08 PM
202410_NH_DUR_Meeting_Minutes.pdf
Apr 10, 2025 1:21:46 PM
Minutes 12.02.2021.pdf
Mar 13, 2023 12:31:40 PM
Minutes 12.13.2022.pdf
Jun 20, 2023 10:26:04 AM
202312_NH_DUR_Meeting_Minutes.pdf
May 8, 2024 8:23:21 PM
202504_NH_DUR_Meeting_Minutes.pdf
Sep 25, 2025 6:45:05 PM
202405_NH_DUR_Meeting_Minutes.pdf
Oct 18, 2024 7:36:19 PM
202306_NH_DUR_Meeting_Minutes_FINAL.pdf
Dec 16, 2023 3:33:33 AM
Adenosine Triphosphate-Citrate Lyase PA Form.pdf
Jul 5, 2025 7:20:14 PM
Asthma-Allergy Immunomodulator PA Form.pdf
Oct 4, 2024 7:59:12 PM
Bowel Disorders.GI Motility, Chronic PA Form.pdf
Oct 4, 2024 7:59:39 PM
BPH PA Form.pdf
Dec 16, 2024 2:56:50 PM
Brand Name Multisource Drug PA Form.pdf
Jul 5, 2025 7:53:34 PM
Buprenorphine-Naloxone and Buprenorphine (Oral) PA Form.pdf
Jul 5, 2025 7:54:52 PM
Carisoprodol and Combination PA Form.pdf
Jul 5, 2025 7:55:12 PM
Casgevy PA Form.pdf
Mar 26, 2025 6:14:31 PM
CGRP Inhibitor PA Form.pdf
Dec 16, 2024 2:59:33 PM
Cholestatic Pruritus PA Form.pdf
Mar 26, 2025 6:15:03 PM
CNS Stimulants (ADHD.ADD) PA Form.pdf
Oct 4, 2024 8:05:55 PM
Codeine for Pediatric Use PA Form.pdf
Dec 16, 2024 3:00:58 PM
Convenience Kits PA Form.pdf
Dec 16, 2024 3:03:00 PM
Duchenne Muscular Dystrophy PA Form.pdf
Oct 4, 2024 8:06:43 PM
Dupixent PA Form.pdf
Dec 16, 2024 3:03:28 PM
Elevidys PA Form.pdf
Mar 26, 2025 6:15:23 PM
Epidermolysis Bullosa PA Form.pdf
Mar 26, 2025 6:16:14 PM
GLP-1 Receptor Agonist PA Form.pdf
Jul 5, 2025 7:21:22 PM
Hematopoietic Agent PA Form.pdf
Mar 26, 2025 6:18:02 PM
Hemophilia B Gene Therapy PA Form.pdf
Mar 26, 2025 6:17:30 PM
Hepatitis C PA Form.pdf
Dec 16, 2024 3:06:04 PM
Hetlioz PA Form.pdf
Jul 5, 2025 7:55:40 PM
Human Growth Hormones PA Form.pdf
Jul 5, 2025 7:20:42 PM
Hyaluronic Acid Derivatives Injection PA Form.pdf
Dec 16, 2024 3:07:10 PM
Juxtapid PA Form.pdf
Dec 16, 2024 3:08:01 PM
Kebilidi_Fax_Form.pdf
Jul 5, 2025 7:28:12 PM
Lenmeldy PA Form.pdf
Mar 26, 2025 6:19:22 PM
Long-acting Opioid Analgesic PA Form.pdf
Dec 16, 2024 3:13:19 PM
Lyfgenia PA Form.pdf
Mar 26, 2025 6:15:45 PM
Methadone PA Form.pdf
Jul 5, 2025 7:56:05 PM
Monoclonal Antibody for Alzheimers PA Form.pdf
Dec 16, 2024 3:14:45 PM
Morphine Milligram Equivalent (MME) PA Form.pdf
Jul 5, 2025 7:56:25 PM
Movement Disorders PA Form.pdf
Dec 16, 2024 3:16:04 PM
New Drug Product PA Form.pdf
Jul 5, 2025 7:56:59 PM
Niemann-Pick_Disease_Fax_Form.pdf
Jul 5, 2025 7:28:37 PM
Non-Preferred Drug PA Form.pdf
Oct 4, 2024 8:26:17 PM
Oral Isotretinoin PA Form.pdf
Jul 5, 2025 7:57:17 PM
PCSK9 PA Form.pdf
Jul 5, 2025 7:22:55 PM
Primary Biliary Cholangitis PA Form.pdf
Mar 26, 2025 6:17:05 PM
Psychoactive Meds for Children under 5 Criteria PA Form.pdf
Jul 5, 2025 7:59:00 PM
Psychotropic Meds Duplicate Therapy Peds 6 and above PA Form.pdf
Jul 5, 2025 8:00:05 PM
Pulmonary Arterial Hypertension PDE-5 PA Form.pdf
Jul 5, 2025 7:23:52 PM
Rezdiffra PA Form.pdf
Mar 26, 2025 6:19:47 PM
Rho Kinase Inhibitor PA Form.pdf
Dec 16, 2024 3:17:46 PM
Roctavian PA Form.pdf
Jul 5, 2025 8:00:41 PM
Second-Line Antifungal PA Form.pdf
Jul 5, 2025 8:02:58 PM
Short-Acting Fentanyl PA Form.pdf
Oct 4, 2024 8:30:42 PM
Skin Disorders PA Form.pdf
Jul 5, 2025 7:24:22 PM
Skysona PA Form.pdf
Oct 4, 2024 8:31:50 PM
Spinal Muscular Atrophy PA Form.pdf
Oct 4, 2024 8:32:19 PM
Spravato PA Form.pdf
Jul 5, 2025 7:25:41 PM
Synagis PA Form.pdf
Jul 5, 2025 8:03:23 PM
Systemic Immunomodulators Medication PA Form.pdf
Jul 5, 2025 7:27:30 PM
Topical Retinoids PA Form.pdf
Dec 16, 2024 3:31:34 PM
Verquvo PA Form.pdf
Jul 5, 2025 8:03:45 PM
Vuity PA Form.pdf
Jul 5, 2025 8:04:40 PM
Wakix PA Form.pdf
Mar 26, 2025 6:16:39 PM
Weight Management PA Form.pdf
Jul 5, 2025 7:26:01 PM
Winrevair_Fax_Form.pdf
Jul 5, 2025 7:28:56 PM
Zurzuvae PA Form.pdf
Mar 26, 2025 6:20:08 PM
Zynteglo PA Form.pdf
Oct 4, 2024 8:37:44 PM
COVID-19 Testing and Treatment Group Coverage Ending.pdf
Mar 7, 2023 9:35:27 AM
Notification PDL update 1.2025.pdf
Jan 7, 2025 6:05:58 PM
Notification 02.01.2023 Clinical PA Updates-Web Portal Info-Email.pdf
Mar 13, 2023 1:09:57 PM
Notification 03.15.2023 Pharmacist Provided Medical Services.pdf
Mar 20, 2023 3:05:18 PM
Notification 03.28.2023 Standing Orders OTC COVID Test Kits.pdf
Mar 28, 2023 9:19:05 AM
Notification 04.13.2023 Makena Withdrawal.pdf
Apr 14, 2023 9:38:35 AM
Notification 06.01.2023 July PDL update.pdf
Jun 1, 2023 7:53:18 AM
Notification CC.PDL 6.2025.pdf
Jun 11, 2025 1:54:43 PM
Notification 06.20.2023 July PDL update.pdf
Jun 20, 2023 8:29:00 AM
Notification 06.30.2023 August Clinical PA Updates.pdf
Jun 30, 2023 10:32:42 AM
Notification PDL update 10.2025.pdf
Aug 29, 2025 12:19:39 PM
Notification Copay 9.2025.pdf
Sep 12, 2025 2:17:15 PM
Notification 1.23.2024 Standing Order Opioid Antagonist.pdf
Jan 23, 2024 3:10:05 PM
Notification 1.26.2024 PDL.CC update effective 3.1.2024.pdf
Jan 26, 2024 1:59:12 PM
Provider Notice for GLP-1s-10-9-2025.pdf
Oct 9, 2025 3:03:54 PM
NH_FaxBlast_COVID update .pdf
Sep 25, 2024 3:41:03 PM
Notification 12.2.2024.pdf
Dec 2, 2024 9:53:11 PM
Notification 12.1.2023 Carve out Program effective 1.1.2024.pdf
Dec 1, 2023 6:15:14 PM
Notification 340B 2.2025.pdf
Feb 7, 2025 7:16:19 PM
Notification 340B Program effective Jan 2024.pdf
Nov 2, 2023 4:20:32 PM
NH Notification CC update 6.14.pdf
Jun 17, 2024 1:27:38 PM
Notification PDL update 8.1.2024.pdf
Aug 1, 2024 2:49:45 PM
Pharmacy Language Access Services Reminder.pdf
Aug 11, 2023 5:37:37 PM
Brand Preferred 10.1.2025.pdf
Aug 29, 2025 12:57:41 PM
CMS Rebate Participating Manufacturers.pdf
Jul 11, 2025 3:45:32 PM
NH DSP LIST 20251001.pdf
Sep 25, 2025 6:29:42 PM
Dose Optimization Program.pdf
Apr 29, 2025 7:49:00 PM
MAC Price Research Request Form.pdf
Sep 30, 2024 8:53:56 PM
Maintenance Medications.pdf
Oct 3, 2024 1:31:47 PM
NHRx_MAC_listing.pdf
Sep 9, 2025 6:57:14 PM
Non-Legend Drug List.pdf
Oct 3, 2024 1:45:38 PM
Payer Specification.pdf
Oct 3, 2024 1:16:38 PM
Pharmacy Provider Manual - Revised 6.16.2023.pdf
Dec 16, 2024 2:08:16 PM
NHRx_PDL (8).pdf
Oct 7, 2025 12:38:53 PM
NHRx_PDL.pdf
Aug 4, 2025 2:41:43 PM
Quantity Limit Program.pdf
Aug 4, 2025 3:03:59 PM
Third Party Liability Other Payer ID Codes.pdf
Mar 10, 2023 1:26:43 PM
Dose Optimization Program.pdf
Apr 29, 2025 7:49:36 PM
Maintenance Medications.pdf
Oct 3, 2024 3:22:26 PM
Non-Legend Drug List.pdf
Oct 3, 2024 3:22:50 PM
NH_PDL 7.14.2025.pdf
Aug 4, 2025 2:42:21 PM
NHRx_PDL (8).pdf
Oct 7, 2025 12:39:22 PM
Quantity Limit Program.pdf
Aug 4, 2025 3:04:48 PM
Multi-Ingredient Compound Reference.pdf
Oct 3, 2024 3:19:42 PM