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Pharmacy Prior Authorization AETNA BETTER HEALTH VIRGINIA CCC PLUS and MEDALLION/FAMAS 4.0 Colony Stimulating Factors (Medicaid) This fax machine is located in a secure location as required by HIPAA
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ABH-VA-CCC-Plus and Medallion FAMIS-40 Colony Stimulating Factors PA form accessible PDF is needed by individuals who are seeking colony stimulating factor medication under the specified programs and requirements. This form is typically required by healthcare providers and medical facilities to assess the eligibility and medical need of the individual for colony stimulating factors.

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