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Document Name: Bulletin #: Date Range: To

Document NameBulletin NumberDateView
Short-Stock - Fluvastatin Sodium 40mg1952017-Nov-21Word PDF
Short-Stock - Clonazepam 0.5 mg1942017-Nov-21Word PDF
Update: Short-Stock - Olmesartan/Hydrochlorothiazide 40mg/25mg1932017-Nov-17Word PDF
Diabetic Listing - Change in Manufacturer Name1922017-Nov-10Word PDF
Revision to Bulletin #185 (NIDPF Additions - November 1, 2017)1912017-Nov-08Word PDF
Online version of the NIDPF Vol. 77 effective November 1, 20171902017-Nov-01Word PDF
Diabetic PIN - Medi+Sure Blood Glucose Test Strips (50)1892017-Oct-31Word PDF
Short-Stock-Valproic Acid 250 mg1882017-Oct-30Word PDF
NLPDP Upgrade October 28, 20171872017-Oct-27Word PDF
NLPDP Benefit Status Effective November 1, 20171862017-Oct-26Word PDF
NIDPF Vol. 77 Supplement Effective November 1, 2017 - Refer to Bulletin #186 for Benefit Status1852017-Oct-26Word PDF
Short- Stock-Fluvoxamine Maleate 50 mg 1842017-Oct-25Word PDF
New Benefit Additions: Basaglar_OPEN benefit1832017-Oct-23Word PDF
Criteria Update: Levemir 1822017-Oct-23Word PDF
Update: Short-Stock - Bethamethasone Dipropionate/Salicylic Acid 0.05 percent1812017-Oct-20Word PDF
Update: Short-Stock - Buprenorphine/Naloxone 8mg/2mg1802017-Oct-20Word PDF
Short-Stock - Desmopressin 0.1 mg1792017-Oct-17Word PDF
Updated Version: New Benefit Addition: Grastofil1782017-Oct-17Word PDF
Short-Stock - Olmesartan/Hydrochlorothiazide 40mg/25mg1772017-Oct-17Word PDF
Product Delisting - Flonase 50 MCG Nasal Spray1762017-Oct-13Word PDF
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Document Name: Date Range: To

Document NameDateView
Coverage Status Table - November 1, 20172017-Nov-22 PDF
Coverage Status Table - October 1, 20172017-Oct-13 PDF
Coverage Status Table - September 1, 20172017-Sep-27 PDF
Coverage Status Table - July 1, 20172017-Jul-12 PDF
Coverage Status Table - June, 20172017-Jun-16 PDF
Coverage Status Table - April, 20172017-Apr-11 PDF
Coverage Status Table - March 2, 20172017-Mar-08 PDF
Coverage Status Table - February 10, 20172017-Feb-10 PDF
Coverage Status Table - January 11, 20172017-Jan-13 PDF
Coverage Status Table - December 3, 20162016-Dec-07 PDF
Coverage Status Table - November 3, 20162016-Nov-04 PDF
Coverage Status Table - October 12, 20162016-Oct-13 PDF
Coverage Status Table - September 1, 20162016-Sep-02 PDF
Coverage Status Table - May 1, 20162016-May-12 PDF
Coverage Status Table - March 1, 20162016-Mar-08 PDF
Coverage Status Table - February 1, 20162016-Feb-18 PDF
Coverage Status Table - January 1, 20162016-Jan-15 PDF
(Revised) Coverage Status Table - December 1, 20152015-Dec-15 PDF
Coverage Status Table - December 1, 20152015-Dec-11 PDF
 
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Document Name: Date Range: To

Document NameDateView
Diabetic Listing - November 10, 2017 (Refer to Bulletin #192 posted on November 10, 2017)2017-Nov-10Word PDF
Diabetic Listing - October 31, 2017 (Refer to Bulletin #189 posted on October 31, 2017)2017-Oct-31Word PDF
Diabetic Listing - September 22, 2017 (Refer to Bulletin #164 posted on September 22, 2017)2017-Sep-22Word PDF
Diabetic Listing - April 6, 2017 (Refer to Bulletin #73 posted on April 6, 2017)2017-Apr-06Word PDF
Diabetic Listing - July 29, 2016 (Refer to Bulletins #134 and #140 posted on July 29, 2016)2016-Jul-29Word PDF
Diabetic Listing - July 27, 2016 (Refer to Bulletin #134 posted on July 27, 2016)2016-Jul-28Word PDF
Diabetic Listing - June 22, 2016 (Refer to Bulletin #110 posted on June 22, 2016)2016-Jun-22Word PDF
Diabetic Listing - March 3, 2016 (Refer to Bulletin #40 posted on March 3, 2016)2016-Mar-03Word PDF
Diabetic Listing - January 20, 2016 (Refer to Bulletin #10 posted on January 20, 2016)2016-Jan-20Word PDF
Diabetic Listing - January 8, 2016 (Refer to Bulletin #02 posted on January 8, 2016)2016-Jan-08Word PDF
 
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Document Name: Bulletin #: Date Range: To

Document NameBulletin NumberDateView
New Benefit Additions: Basaglar_OPEN benefit1832017-Oct-23Word PDF
Criteria Update: Levemir 1822017-Oct-23Word PDF
Updated Version: New Benefit Addition: Grastofil1782017-Oct-17Word PDF
Benefit List Update: New Addition: Xigduo1672017-Sep-25Word PDF
Benefit List Update: Hepatitis C therapies: Daklinza and Sunvepra1622017-Sep-18Word PDF
Benefit List Update: Hepatitis C therapies: Zepatier1602017-Sep-14Word PDF
Benefit List Update: Hepatitis C therapies: Holkira1592017-Sep-14Word PDF
Benefit List Update: Hepatitis C therapies: Epclusa, Havoni, Sovaldi 1582017-Sep-14Word PDF
Benefit List Update: New Addition: Genvoya 1552017-Sep-01Word PDF
Benefit List Update: New addition to an existing category: Humira for ulcerative colitis (UC)1372017-Aug-04Word PDF
Benefit List Update: New Drug Therapy_Xolair CIU1272017-Jul-19Word PDF
Benefit List Update: Special Authorization Criteria_Inlyta (axitinib)1262017-Jul-17Word PDF
New Drug Therapy - COTELLIC ZELBORAF Effective June 1, 20171252017-Jul-17Word PDF
Benefit List Update: New Additions_Ferriprox1072017-Jun-20Word PDF
Benefit list update: Additions to existing categories citalopram 10mg-OPEN benefit1022017-Jun-15Word PDF
Benefit list additions: OPEN benefit_Mar-Citalopram 10mg & Mar-Amlodipine 2.5mg942017-May-29Word PDF
Benefit List Updates_New addition_Plegridy 922017-May-29Word PDF
Benefit list updates_New additions to existing categories_Eylea_BRVO882017-May-15Word PDF
UPDATE: Benefit list updates_New additions_Entyvio 300mg IV872017-May-11Word PDF
Benefit List Update: New addition to existing category: Golimumab (SIMPONI) for ulcerative colitis812017-Apr-28Word PDF
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Page 1 of 5
Document Name: Bulletin #: Date Range: To

Document NameBulletin NumberDateView
Short-Stock - Fluvastatin Sodium 40mg1952017-Nov-21Word PDF
Short-Stock - Clonazepam 0.5 mg1942017-Nov-21Word PDF
Update: Short-Stock - Olmesartan/Hydrochlorothiazide 40mg/25mg1932017-Nov-17Word PDF
Short-Stock-Valproic Acid 250 mg1882017-Oct-30Word PDF
Short- Stock-Fluvoxamine Maleate 50 mg 1842017-Oct-25Word PDF
Update: Short-Stock - Bethamethasone Dipropionate/Salicylic Acid 0.05 percent1812017-Oct-20Word PDF
Update: Short-Stock - Buprenorphine/Naloxone 8mg/2mg1802017-Oct-20Word PDF
Short-Stock - Desmopressin 0.1 mg1792017-Oct-17Word PDF
Short-Stock - Olmesartan/Hydrochlorothiazide 40mg/25mg1772017-Oct-17Word PDF
Update: Short-Stock - Valproic Acid 250 mg1732017-Sep-29Word PDF
Update: Short-Stock - Isosorbide-5-Mononitrate 60 mg1722017-Sep-29Word PDF
Short-Stock - Olmesartan/Hydrochlorothiazide 40mg/12.5mg1682017-Sep-25Word PDF
Update: Short-Stock - Desogestrel/Ethinyl Estradiol 0.15mg/0.03mg (28's)1662017-Sep-22Word PDF
Update: Short-Stock - Felodipine 2.5mg ER1652017-Sep-22Word PDF
Short-Stock - Valproic Acid 250mg1632017-Sep-20Word PDF
Update: Short-Stock - Desogestrel/Ethinyl Estradiol 0.15mg/0.03mg Tablet1612017-Sep-15Word PDF
Update: Short-Stock - Clonazepam 0.5 mg1542017-Sep-01Word PDF
Short-Stock - Methotrexate 25mg/ml1512017-Aug-30Word PDF
Short-Stock - Clonazepam 0.5 mg1502017-Aug-29Word PDF
Short-Stock - Felodipine 2.5 mg ER1492017-Aug-29Word PDF
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Document Name: Bulletin #: Date Range: To

Document NameBulletin NumberDateView
Revision to Bulletin #185 (NIDPF Additions - November 1, 2017)1912017-Nov-08Word PDF
Online version of the NIDPF Vol. 77 effective November 1, 20171902017-Nov-01Word PDF
NLPDP Benefit Status Effective November 1, 20171862017-Oct-26Word PDF
NIDPF Vol. 77 Supplement Effective November 1, 2017 - Refer to Bulletin #186 for Benefit Status1852017-Oct-26Word PDF
Online version of the NIDPF Vol. 77 effective October 1, 20171742017-Sep-29Word PDF
NLPDP Benefit Status Effective October 1, 20171712017-Sep-25Word PDF
NIDPF Vol. 77 Supplement Effective October1, 2017 - Refer to Bulletin #171 for Benefit Status1702017-Sep-25Word PDF
Discontinued Products and Categories Delisted from NIDPF (Vol. 77) effective October 1, 20171692017-Sep-25Word PDF
Online version of the NIDPF Vol. 76 effective September 1, 20171562017-Sep-01Word PDF
Update: NLPDP Benefit Status Effective September 1, 20171532017-Aug-30Word PDF
Update: NIDPF Vol. 76 Supplement Eff September 1, 2017 - Refer to Bulletin #153 for Benefit Status1522017-Aug-30Word PDF
NLPDP Benefit Status Effective September 1, 20171432017-Aug-21Word PDF
NIDPF Vol. 76 Supplement Effective September 1, 2017 - Refer to Bulletin #143 for Benefit Status1422017-Aug-21Word PDF
Online version of the NIDPF Vol. 76 effective August 1, 20171352017-Aug-01Word PDF
NLPDP Benefit Status Effective August 1, 20171292017-Jul-20Word PDF
NIDPF Vol. 76 Supplement Effective August 1, 2017 - Refer to Bulletin #129 for Benefit Status1282017-Jul-20Word PDF
Online version of the NIDPF Vol. 76 effective July 1, 20171172017-Jun-30Word PDF
NLPDP Benefit Status Effective July 1, 20171112017-Jun-26Word PDF
NIDPF Vol. 76 Supplement Effective July 1, 2017 - Refer to Bulletin #111 for Benefit Status1102017-Jun-26Word PDF
Online version of NIDPF Vol. 76 Supplement effective June 1, 2017952017-Jun-02Word PDF
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Document Name: Date Range: To

Document NameDateView
2017 Payment Schedule2016-Dec-19Word PDF
NLPDP Application for Participation2016-Dec-06Word PDF
2016 Payment Schedule2015-Dec-17Word PDF
 
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