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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.
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 first-line DMARD. The limits are 8 doses of Enbrel 25mg or 4 doses of Enbrel 50mg per 28 days.
ENDOCET® 01/01/00 The limits for are 12 tablets per day for Endocet 5-325mg , 8 tablets per day for 7.5-325mg and 7.5-500mg, and 6 tablets per day for 10-325mg and 10-650mg.
EPIDUO® 01/01/11 Prior authorization for medical necessity may be required.
EPIVIR 07/01/12 The limits are 1 tablet or 32 mL per day.
EPZICOM 07/01/12 The limits are 1 tablet per day.

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