Rational Drug Therapy Program

WVBMS Drug Therapy Guidelines ***************************************************

Injectable Medications ***************************************************

All injectable medications must have prior approval before dispensing.

Medications are checked for appropriate diagnosis, appropriate dose and if there any oral alternatives to the particular agent. Provider must justify why a patient cannot use or take oral therapy.

Exemptions to this policy are:

haloperidol

fluphenazine

medroxy-progesterone

cyanocobalamin

insulins

epinephrine syringes for allergic reaction

glucagons emergency kit

IV/Injectable criteria

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Rational Drug Therapy Program FAX, Phone, or Mail Completed Form To:

WV Bureau for Medical Services FAX # 1-800-531-7787

P.O. Box 9511 HSCN Phone # 1-800-847-3859

Morgantown, WV 26506-9511