Product Name 
Implementation Date 
Guideline 
EDARBI®
 04/01/11 
Edarbi 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). 
EDARBYCLOR®
 07/01/12 
Edarbyclor 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). 
EDEX®
 07/01/10 
Prior authorization for medical necessity may be required. Patients must be at least 18 years of age. 
EDLUAR®
 07/06/09 
The limits are 1 tablet per day. 
EDURANT
 07/01/12 
The limits are 1 tablet per day. 
EFFEXOR XR®
 07/01/05 
The limits are 1 capsule per day, except Effexor XR 75mg which has a limit of 3 capsules per day. 
ELIQUIS
 07/01/13 
The limits are 2 tablets per day for Eliquis 2.5mg and 4 tablets per day for Eliqus 5 mg. 
EMBEDA®
 09/09/09 
The limits are 2 capsules per day. 
EMEND®
 11/12/08 
The limits are 4 capsules per 30 days for Emend 80mg, 2 capsules per 30 days for Emend 125mg, and 2 packs (6 capsules) per 30 days for Emend 125mg/80mg packs. 
EMTRIVA
 07/01/12 
The limits are 1 capsule or 24 mL per day. 
ENBREL®
 05/17/99 
Enbrel may be subject to step therapy requirements. Patients must have trial and failure of a firstline DMARD. The limits are 8 doses of Enbrel 25mg or 4 doses of Enbrel 50mg per 28 days. 
ENDOCET®
 01/01/00 

EPIDUO®
 01/01/11 
Prior authorization for medical necessity may be required. 
EPIVIR
 07/01/12 
The limits are 2 tablets for Epivir 150 mg, 1 tablet for Epivir 300 mg or 960 ml/month for Epivir solution. 
EPZICOM
 07/01/12 
The limits are 1 tablet per day. 