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All A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Product Name Implementation Date Guideline
BECONASE AQ® 11/13/01 The limits are 2 bottles per 30 days.
BENICAR HCT® 01/01/11 Benicar HCT may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
BENICAR® 01/01/11 Benicar may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
BETASERON® 10/01/12 The limits are 14 vial/syringe units per 28 days and 1 kit (14 prefilled syringes) per 28 days.
BETHKIS® 01/01/14 Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Cayston.
BINOSTO" 01/01/13 The limits are 4 tablets per 28 days.
BIO-T-GEL® 10/01/12 The limits are 2 packets per day.
BONIVA® 06/01/05 The limits are 1 tablet per 30 days for Boniva 150mg.
BOSULIF® 11/15/12 Prior authorization for medical necessity is required. The limits are 1 tablet per day.
BREO ELLIPTA® 01/01/14 The limits are 2 blisters per day.
BUPHENYL 07/01/13 Prior authorization for medical necessity is required.
BUTALBITAL COMPOUND 04/01/13 The limits are 6 tablets per day.
BUTALBITAL/ACETAMINOPHEN 04/01/13 The limits are 6 tablets per day.
BUTRANS" 04/01/11 The limits are 4 transdermal systems per 30 days.
BYDUREON® 04/01/12 Bydureon may be subject to step therapy requirements. Patients must have trial and failure of one or more of the following antidiabetic agents: metformin, sulfonylurea, combinations of metformin or sulfonylureas, or basal insulin (Lantus or Levemir). The limits are 4 vials per 30 days.

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