HEDIS Tips 2018
HEDIS Tip Sheet for Woman’s Health Measures
HEDIS Measure Definitions What You Can Do Coding Tips
PPC ‐ Prenatal and Postpartum Care
Women who delivered a live baby and had
prenatal care during 1st trimester or within 42
days if enrollment and Po
PA Criteria
Updated 10/2018
Effective 10/01/2018
Prior Authorization Group ACITRETIN
Drug Names ACITRETIN
Covered Uses All FDA-approved indications not otherwise excluded from Part D, prevention of
non-melanoma skin cancers in high risk individuals.
Exclusion Criteria
Required Medical
Virginia Step Therapy Requirements August 2017
1
Medications that require Step Therapy (ST) require trial and failure of preferred formulary agents prior to their
authorization. If the prerequisite medications have been filled within the specified time frame, the prescription will
auto
2018 Prior Authorization Criteria
Updated 12/2017
Effective 01/01/2018
1
PA Criteria
Prior Authorization Group ACITRETIN
Drug Names ACITRETIN
Covered Uses All FDA-approved indications not otherwise excluded from Part D, prevention of
non-melanoma skin cancers in high risk individua
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